Method of applying a buttress to a surgical stapler end effector

ABSTRACT

A buttress is applied to an end effector of a surgical stapler. The buttress is loaded on a platform of a buttress applier cartridge. The end effector is closed upon the platform. An adhesive layer of the buttress secures the buttress to the end effector. The buttress is thus adhered to the end effector when the end effector is opened. The end effector is then actuated on tissue of a patient, thereby stapling the buttress to the tissue.

PRIORITY

This application claims priority to U.S. Patent App. No. 62/209,041,entitled “Method and Apparatus for Applying a Buttress to End Effectorof a Surgical Stapler,” filed Aug. 25, 2015, the disclosure of which isincorporated by reference herein.

BACKGROUND

In some settings, endoscopic surgical instruments may be preferred overtraditional open surgical devices since a smaller incision may reducethe post-operative recovery time and complications. Consequently, someendoscopic surgical instruments may be suitable for placement of adistal end effector at a desired surgical site through the cannula of atrocar. These distal end effectors may engage tissue in a number of waysto achieve a diagnostic or therapeutic effect (e.g., endocutter,grasper, cutter, stapler, clip applier, access device, drug/gene therapydelivery device, and energy delivery device using ultrasonic vibration,RF, laser, etc.). Endoscopic surgical instruments may include a shaftbetween the end effector and a handle portion, which is manipulated bythe clinician. Such a shaft may enable insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby facilitatingpositioning of the end effector within the patient. Positioning of anend effector may be further facilitated through inclusion of one or morearticulation joints or features, enabling the end effector to beselectively articulated or otherwise deflected relative to thelongitudinal axis of the shaft.

Examples of endoscopic surgical instruments include surgical staplers.Some such staplers are operable to clamp down on layers of tissue, cutthrough the clamped layers of tissue, and drive staples through thelayers of tissue to substantially seal the severed layers of tissuetogether near the severed ends of the tissue layers. Merely exemplarysurgical staplers are disclosed in U.S. Pat. No. 4,805,823, entitled“Pocket Configuration for Internal Organ Staplers,” issued Feb. 21,1989; U.S. Pat. No. 5,415,334, entitled “Surgical Stapler and StapleCartridge,” issued May 16, 1995; U.S. Pat. No. 5,465,895, entitled“Surgical Stapler Instrument,” issued Nov. 14, 1995; U.S. Pat. No.5,597,107, entitled “Surgical Stapler Instrument,” issued Jan. 28, 1997;U.S. Pat. No. 5,632,432, entitled “Surgical Instrument,” issued May 27,1997; U.S. Pat. No. 5,673,840, entitled “Surgical Instrument,” issuedOct. 7, 1997; U.S. Pat. No. 5,704,534, entitled “Articulation Assemblyfor Surgical Instruments,” issued Jan. 6, 1998; U.S. Pat. No. 5,814,055,entitled “Surgical Clamping Mechanism,” issued Sep. 29, 1998; U.S. Pat.No. 6,978,921, entitled “Surgical Stapling Instrument Incorporating anE-Beam Firing Mechanism,” issued Dec. 27, 2005; U.S. Pat. No. 7,000,818,entitled “Surgical Stapling Instrument Having Separate Distinct Closingand Firing Systems,” issued Feb. 21, 2006; U.S. Pat. No. 7,143,923,entitled “Surgical Stapling Instrument Having a Firing Lockout for anUnclosed Anvil,” issued Dec. 5, 2006; U.S. Pat. No. 7,303,108, entitled“Surgical Stapling Instrument Incorporating a Multi-Stroke FiringMechanism with a Flexible Rack,” issued Dec. 4, 2007; U.S. Pat. No.7,367,485, entitled “Surgical Stapling Instrument Incorporating aMultistroke Firing Mechanism Having a Rotary Transmission,” issued May6, 2008; U.S. Pat. No. 7,380,695, entitled “Surgical Stapling InstrumentHaving a Single Lockout Mechanism for Prevention of Firing,” issued Jun.3, 2008; U.S. Pat. No. 7,380,696, entitled “Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism,”issued Jun. 3, 2008; U.S. Pat. No. 7,404,508, entitled “SurgicalStapling and Cutting Device,” issued Jul. 29, 2008; U.S. Pat. No.7,434,715, entitled “Surgical Stapling Instrument Having MultistrokeFiring with Opening Lockout,” issued Oct. 14, 2008; U.S. Pat. No.7,721,930, entitled “Disposable Cartridge with Adhesive for Use with aStapling Device,” issued May 25, 2010; U.S. Pat. No. 8,408,439, entitled“Surgical Stapling Instrument with An Articulatable End Effector,”issued Apr. 2, 2013; and U.S. Pat. No. 8,453,914, entitled “Motor-DrivenSurgical Cutting Instrument with Electric Actuator Directional ControlAssembly,” issued Jun. 4, 2013. The disclosure of each of theabove-cited U.S. patents is incorporated by reference herein.

While the surgical staplers referred to above are described as beingused in endoscopic procedures, it should be understood that suchsurgical staplers may also be used in open procedures and/or othernon-endoscopic procedures. By way of example only, a surgical staplermay be inserted through a thoracotomy, and thereby between a patient'sribs, to reach one or more organs in a thoracic surgical procedure thatdoes not use a trocar as a conduit for the stapler. Such procedures mayinclude the use of the stapler to sever and close a vessel leading to alung. For instance, the vessels leading to an organ may be severed andclosed by a stapler before removal of the organ from the thoraciccavity. Of course, surgical staplers may be used in various othersettings and procedures.

Examples of surgical staplers that may be particularly suited for usethrough a thoracotomy are disclosed in U.S. Patent Pub. No.2014/0243801, entitled “Surgical Instrument End Effector ArticulationDrive with Pinion and Opposing Racks,” published Aug. 28, 2014; U.S.Patent Pub. No. 2014/0239041, entitled “Lockout Feature for MovableCutting Member of Surgical Instrument,” published Aug. 28, 2014; U.S.Patent Pub. No. 2014/0239042, entitled “Integrated Tissue Positioningand Jaw Alignment Features for Surgical Stapler,” published Aug. 28,2014; U.S. Patent Pub. No. 2014/0239036, entitled “Jaw Closure Featurefor End Effector of Surgical Instrument,” published Aug. 28, 2014; U.S.Patent Pub. No. 2014/0239040, entitled “Surgical Instrument withArticulation Lock having a Detenting Binary Spring,” published Aug. 28,2014; U.S. Patent Pub. No. 2014/0239043, entitled “Distal Tip Featuresfor End Effector of Surgical Instrument,” published Aug. 28, 2014; U.S.Patent Pub. No. 2014/0239037, entitled “Staple Forming Features forSurgical Stapling Instrument,” published Aug. 28, 2014; U.S. Patent Pub.No. 2014/0239038, entitled “Surgical Instrument with Multi-DiameterShaft,” published Aug. 28, 2014; and U.S. Patent Pub. No. 2014/0239044,entitled “Installation Features for Surgical Instrument End EffectorCartridge,” published Aug. 28, 2014. The disclosure of each of theabove-cited U.S. patent Publications is incorporated by referenceherein.

Additional surgical stapling instruments are disclosed in U.S. Pat. No.8,801,735, entitled “Surgical Circular Stapler with Tissue RetentionArrangements,” issued Aug. 12, 2014; U.S. Pat. No. 8,141,762, entitled“Surgical Stapler Comprising a Staple Pocket,” issued Mar. 27, 2012;U.S. Pat. No. 8,371,491, entitled “Surgical End Effector Having ButtressRetention Features,” issued Feb. 12, 2013; U.S. Pub. No. 2014/0263563,entitled “Method and Apparatus for Sealing End-to-End Anastomosis”published Sep. 18, 2014; U.S. Pub. No. 2014/0246473, entitled “RotaryPowered Surgical Instruments with Multiple Degrees of Freedom,”published Sep. 4, 2014; U.S. Pub. No. 2013/0206813, entitled “LinearStapler,” published Aug. 15, 2013; U.S. Pub. No. 2008/0169328, entitled“Buttress Material for Use with a Surgical Stapler,” published Jul. 17,2008; U.S. patent application Ser. No. 14/300,804, entitled “Woven andFibrous Materials for Reinforcing a Staple Line,” filed Jun. 10, 2014;U.S. patent application Ser. No. 14/300,811, entitled “Devices andMethods for Sealing Staples in Tissue”; and U.S. patent application Ser.No. 14/498,070, entitled “Radically Expandable Staple Line” filed Sep.26, 2014. The disclosure of each of the above-cited U.S. patents, U.S.patent Publications, and U.S. patent applications is incorporated byreference herein.

In some instances, it may be desirable to equip a surgical staplinginstrument with a buttress material to reinforce the mechanicalfastening of tissue provided by staples. Such a buttress may prevent theapplied staples from pulling through tissue and may otherwise reduce arisk of tissue tearing at or near the site of applied staples.

While various kinds of surgical stapling instruments and associatedcomponents have been made and used, it is believed that no one prior tothe inventor(s) has made or used the invention described in the appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 depicts a perspective view of an exemplary articulating surgicalstapling instrument;

FIG. 2 depicts a perspective view of an end effector of the instrumentof FIG. 1, with the end effector in an open configuration;

FIG. 3 depicts an exploded perspective view of the end effector of FIG.2;

FIG. 4 depicts a perspective view of an exemplary upper buttress and anexemplary lower buttress, each of which may be applied to the endeffector of FIG. 2;

FIG. 5A depicts a cross-sectional end view of a portion of the endeffector of FIG. 2 with a buttress assembly formed by the buttresses ofFIG. 4 applied to the end effector, with tissue positioned between thebuttresses in the end effector, and with the anvil in an open position;

FIG. 5B depicts a cross-sectional end view of the combined end effectorand buttress assembly of FIG. 5A, with tissue positioned between thebuttresses in the end effector, and with the anvil in a closed position;

FIG. 5C depicts a cross-sectional view of a staple and the buttressassembly of FIG. 5A having been secured to the tissue by the endeffector of FIG. 2;

FIG. 6 depicts a perspective view of staples and the buttress assemblyof FIG. 5A having been secured to the tissue by the end effector of FIG.2;

FIG. 7 depicts a perspective view of an exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 5A;

FIG. 8 depicts a top plan view of the buttress applier cartridge of FIG.7;

FIG. 9 depicts an exploded perspective view of the buttress appliercartridge of FIG. 7;

FIG. 10 depicts a perspective view of a sled retainer of the buttressapplier cartridge of FIG. 7;

FIG. 11 depicts a perspective view of a chassis of the buttress appliercartridge of FIG. 7;

FIG. 12 depicts a top plan view of an actuator sled of the buttressapplier cartridge of FIG. 7;

FIG. 13 depicts a perspective view of a retainer of the buttress appliercartridge of FIG. 7;

FIG. 14A depicts a top plan view of the buttress applier cartridge ofFIG. 7, with a buttress assembly loaded on a platform of the buttressapplier cartridge, and with retainers positioned to secure the buttressassembly to the platform;

FIG. 14B depicts a top plan view of the buttress applier cartridge ofFIG. 7, with a buttress assembly loaded on a platform of the buttressapplier cartridge, and with retainers positioned to release the buttressassembly to the platform;

FIG. 15A depicts a top plan view of the buttress applier cartridge ofFIG. 7, with a housing member removed, with a buttress assembly loadedon a platform of the buttress applier cartridge, and with retainerspositioned to secure the buttress assembly to the platform;

FIG. 15B depicts a top plan view of the buttress applier cartridge ofFIG. 7, with a housing member removed, with a buttress assembly loadedon a platform of the buttress applier cartridge, and with retainerspositioned to release the buttress assembly to the platform;

FIG. 16A depicts a perspective view of the end effector of FIG. 2 andthe buttress applier cartridge of FIG. 7, with the end effectorapproaching the buttress applier cartridge;

FIG. 16B depicts a perspective view of the end effector of FIG. 2 andthe buttress applier cartridge of FIG. 7, with the buttress appliercartridge positioned in the end effector;

FIG. 17A depicts a cross-sectional side view of the end effector of FIG.2 and the buttress applier cartridge of FIG. 7, with the buttressapplier cartridge positioned in the end effector, and with the endeffector in an open configuration;

FIG. 17B depicts a cross-sectional side view of the end effector of FIG.2 and the buttress applier cartridge of FIG. 7, with the buttressapplier cartridge positioned in the end effector, and with the endeffector in a closed configuration;

FIG. 18 depicts a perspective view of another exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 5A;

FIG. 19 depicts an exploded perspective view of the buttress appliercartridge of FIG. 18;

FIG. 20 depicts a perspective view of another exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 5A;

FIG. 21 depicts a top plan view of the buttress applier cartridge ofFIG. 20;

FIG. 22 depicts an exploded perspective view of the buttress appliercartridge of FIG. 20;

FIG. 23 depicts a cross-sectional view of the applier cartridge of FIG.20, taken along line 23-23 of FIG. 21;

FIG. 24 depicts a perspective view of another exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 5A, with a sliding platform in an extended position;

FIG. 25A depicts a top plan view of another exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 5A, with a portion of the housing broken away to reveal internalfeatures, and with a sliding platform in a retracted position;

FIG. 25B depicts a top plan view of the buttress applier cartridge ofFIG. 25A, with a portion of the housing broken away to reveal internalfeatures, and with the sliding platform in an extended position;

FIG. 26A depicts a partial, cross-sectional end view of anotherexemplary buttress applier cartridge positioned in the end effector ofFIG. 2, with the end effector in a partially open configuration, andwith ratcheting retention arms of the buttress applier cartridge in abuttress engaging configuration;

FIG. 26B depicts a partial, cross-sectional end view of the buttressapplier cartridge of FIG. 26A positioned in the end effector of FIG. 2,with the end effector in a closed configuration, thereby driving theratcheting retention arms to a buttress disengaging configuration;

FIG. 26C depicts a partial, cross-sectional end view of the buttressapplier cartridge of FIG. 26A positioned in the end effector of FIG. 2,with the end effector in an open configuration, with the buttressassembly adhered to the end effector, and with the retention armsremaining in the buttress disengaging configuration;

FIG. 27A depicts a partial, cross-sectional detail view of a ratchetingretention arm of the buttress applier cartridge of FIG. 26A in thebuttress engaging configuration;

FIG. 27B depicts a partial, cross-sectional detail view of a ratchetingretention arm of the buttress applier cartridge of FIG. 26A in thebuttress disengaging configuration;

FIG. 28 depicts a partial, cross-sectional end view of another exemplarybuttress applier cartridge, with a platform carrying a plurality ofbuttress assemblies, and with retainer arms in first positions;

FIG. 29 depicts a partial, cross-sectional detail view of a retainer armof the buttress applier cartridge transitioning from the first positionto second and third positions;

FIG. 30 depicts a perspective view of an exemplary alternative staplecartridge that may be loaded into the end effector of FIG. 2, with abuttress loaded thereon by a thread;

FIG. 31 depicts a perspective view of another exemplary alternativestaple cartridge that may be loaded into the end effector of FIG. 2,with another buttress loaded thereon by a thread;

FIG. 32A depicts a cross-sectional side view of the staple cartridge ofFIG. 30, with a wedge sled in a proximal position;

FIG. 32B depicts a cross-sectional side view of the staple cartridge ofFIG. 30, with the wedge sled in a distal position;

FIG. 33 depicts a perspective view of another exemplary alternativebuttress applier cartridge, with a portion of the cartridge cut away toreveal internal components;

FIG. 34 depicts a top plan view of a buttress assembly of the buttressapplier cartridge of FIG. 33;

FIG. 35A depicts a cross-sectional detail view of a buttress retentionmember of the buttress applier cartridge of FIG. 33, with the buttressretention member in a first position;

FIG. 35B depicts a cross-sectional detail view of a buttress retentionmember of the buttress applier cartridge of FIG. 33, with the buttressretention member driven to a second position by the anvil of the endeffector of FIG. 2;

FIG. 36A depicts a partial cross-sectional end view of another exemplaryalternative buttress applier cartridge, with the anvil of the endeffector of FIG. 2 positioned over a platform of the buttress appliercartridge;

FIG. 36B depicts a partial cross-sectional end view of the buttressapplier cartridge of FIG. 36A, with the anvil engaging guide featuresand a buttress on the platform;

FIG. 37 depicts a perspective view of another exemplary alternativebuttress applier cartridge;

FIG. 38 depicts a perspective view of another exemplary alternativebuttress applier cartridge and package with another exemplaryalternative buttress assembly;

FIG. 39 depicts a perspective view of an exemplary alternative buttressassembly;

FIG. 40A depicts an end view of the anvil of the end effector of FIG. 2positioned positioned over the buttress assembly of FIG. 39;

FIG. 40B depicts an end view of the buttress assembly of FIG. 39 securedto the anvil of the end effector of FIG. 2;

FIG. 41 depicts a cross-sectional view of the buttress assembly of FIG.39 secured to tissue and severed;

FIG. 42 depicts a perspective view of a distal end of an exemplaryalternative anvil with a buttress retention clip separated from theanvil;

FIG. 43A depicts a cross-sectional side view of the distal end of theanvil and buttress retention clip of FIG. 42, with the clip retaining abuttress against the anvil;

FIG. 43B depicts a cross-sectional side view of the distal end of theanvil and buttress retention clip of FIG. 42, with the clip releasingthe buttress from the anvil;

FIG. 44 depicts a partial perspective view of an open end of anotherexemplary buttress applier cartridge that may be used to carry and applythe buttress assembly of FIG. 5A;

FIG. 45A depicts a partial, cross-sectional end view of a buttressassembly disposed on a platform of the buttress applier cartridge ofFIG. 44;

FIG. 45B depicts partial, cross-sectional end view of the buttressassembly and platform of FIG. 45A, with an anvil of the end effector ofFIG. 2 pressing the buttress assembly against pressure applying featuresof the platform;

FIG. 45C depicts a partial, cross-sectional end view of the buttressassembly and anvil of FIG. 45B, with the buttress assembly adhered tothe anvil;

FIG. 46A depicts a partial, cross-sectional end view of a buttressassembly disposed on an exemplary variation of the platform of FIG. 45A;

FIG. 46B depicts a partial, cross-sectional end view of the buttressassembly and platform of FIG. 46A, with an anvil of the end effector ofFIG. 2 pressing the buttress assembly against pressure applying featuresof the platform;

FIG. 46C depicts a partial, cross-sectional end view of the buttressassembly and anvil of FIG. 46B, with the buttress assembly adhered tothe anvil;

FIG. 47 depicts a perspective view of another exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 5A;

FIG. 48A depicts a partial, cross-sectional end view of a buttressassembly disposed on a platform of the buttress applier cartridge ofFIG. 47, with the buttress assembly and platform positioned in the endeffector of FIG. 2, and with the end effector in an open configuration;

FIG. 48B depicts a partial, cross-sectional end view of the buttressassembly and platform of FIG. 48A, with the end effector in a closedconfiguration;

FIG. 48C depicts a partial, cross-sectional end view of the buttressassembly and anvil of FIG. 48A, with the end effector in an openconfiguration, and with an upper portion of the buttress assemblyadhered to the anvil and a lower portion of the buttress assemblyadhered to the deck of the staple cartridge;

FIG. 49A depicts a partial, cross-sectional end view of a buttressassembly disposed on an exemplary variation of the platform of FIG. 48A;

FIG. 49B depicts a partial, cross-sectional end view of the buttressassembly and platform of FIG. 49A, with the buttress assembly andplatform positioned in the end effector of FIG. 2, and with the endeffector in a closed configuration;

FIG. 49C depicts a partial, cross-sectional end view of the buttressassembly and anvil of FIG. 49A, with the end effector in an openconfiguration, and with an upper portion of the buttress assemblyadhered to the anvil and a lower portion of the buttress assemblyadhered to the deck of the staple cartridge;

FIG. 50 depicts a partial perspective view of an exemplary alternativeplatform that may be incorporated into a buttress applier cartridge;

FIG. 51 depicts a partial perspective view of the anvil of the endeffector of FIG. 2 compressing a buttress against another exemplaryalternative platform that may be incorporated into a buttress appliercartridge;

FIG. 52 depicts a perspective view of another exemplary alternativeplatform that may be incorporated into a buttress applier cartridge;

FIG. 53 depicts a perspective view of another exemplary alternativeplatform that may be incorporated into a buttress applier cartridge,with an exemplary alternative curved anvil positioned over the platform;

FIG. 54 depicts a partial perspective view of an open end of anotherexemplary buttress applier cartridge that may be used to carry and applythe buttress assembly of FIG. 5A;

FIG. 55A depicts a partial, cross-sectional end view of a platform andbuttress assembly of the buttress applier cartridge of FIG. 54, with aretention post assembly in a non-collapsed state;

FIG. 55B depicts a partial, cross-sectional end view of the platform andbuttress assembly of FIG. 55A, with the end effector of FIG. 2compressing the platform and buttress assembly, thereby transitioningthe retention post assembly to a collapsed state;

FIG. 55C depicts a partial, cross-sectional end view of the platform andbuttress assembly of FIG. 55A, with the end effector in an openconfiguration, with the buttress assembly adhered to the end effector,and with the retention post assembly remaining in a collapsed state inthe platform;

FIG. 56A depicts a partial, cross-sectional end view of a platform andbuttress assembly of another exemplary alternative buttress appliercartridge, with a retention post assembly in an intact state;

FIG. 56B depicts a partial, cross-sectional end view of the platform andbuttress assembly of FIG. 56A, with the end effector of FIG. 2compressing the platform and buttress assembly, thereby transitioningthe retention post assembly to a fractured state;

FIG. 56C depicts a partial, cross-sectional end view of the platform andbuttress assembly of FIG. 56A, with the end effector in an openconfiguration, with the buttress assembly adhered to the end effector,and with a portion of the retention post assembly remaining in afractured state in the platform;

FIG. 57 depicts a perspective view of another exemplary alternativebuttress applier cartridge;

FIG. 58A depicts a partial, cross-sectional detail view of a retentionfeature of the buttress applier cartridge of FIG. 57, with the retentionfeature securing a buttress assembly to the buttress applier cartridge;

FIG. 58B depicts a partial, cross-sectional detail view of the anvil ofthe end effector of FIG. 2 compressing the buttress assembly against theretention feature, thereby deflecting the retention feature;

FIG. 58C depicts a partial, cross-sectional detail view of the anvil ofthe end effector of FIG. 2 with the buttress assembly adhered thereto,spaced away from the retention feature, with the retention featureremaining in the deflected state;

FIG. 59 depicts a perspective view of another exemplary alternativebuttress applier cartridge;

FIG. 60 depicts a cross-sectional side view of another exemplaryalternative buttress applier cartridge, similar to the buttress appliercartridge of FIG. 59, with the end effector of FIG. 2 positioned about aplatform of the buttress applier cartridge, with the end effector in aclosed configuration, and with a staple cartridge of the end effector ina non-spent state;

FIG. 61 depicts a cross-sectional side view of the buttress appliercartridge of FIG. 60, with the end effector of FIG. 2 positioned about aplatform of the buttress applier cartridge, with the end effector in apartially closed configuration, and with a staple cartridge of the endeffector in a spent state;

FIG. 62 depicts a top plan view of another exemplary alternativebuttress applier cartridge, with a platform of the buttress appliercartridge positioned in the end effector of FIG. 2;

FIG. 63 depicts a top plan view of the end effector of FIG. 2 with abuttress from the buttress applier cartridge of FIG. 62, with thebuttress in a skewed position;

FIG. 64A depicts a cross-sectional detail view of an electricallyactivated indicator of a buttress applier cartridge, with the indicatorin an inactivated state;

FIG. 64B depicts a cross-sectional detail view of the indicator of FIG.64A, in an activated state;

FIG. 65 depicts a perspective view of another exemplary alternativebuttress applier cartridge, with a portion of the buttress appliercartridge cut away to reveal internal components, and with a platformpositioned in the end effector of FIG. 2 while the end effector is in anopen configuration;

FIG. 66A depicts a cross-sectional detail view of a fluid transferindicator of the buttress applier cartridge of FIG. 65, with theindicator in a non-actuated state;

FIG. 66B depicts a cross-sectional detail view of the indicator of FIG.66A, with the indicator in an actuated state;

FIG. 67 depicts a perspective cross-sectional view of another exemplaryalternative buttress applier cartridge;

FIG. 68 depicts a perspective view of another exemplary alternativebuttress applier cartridge, disposed in a package, with the package in afirst state;

FIG. 69 depicts a perspective view of the buttress applier cartridge andpackage of FIG. 68, with the package in a second state;

FIG. 70 depicts a top plan view of another exemplary alternativebuttress applier cartridge, with a spent cartridge indicator in adeployed position;

FIG. 71A depicts a partial plan view of the spent cartridge indicator ofFIG. 70 in a retracted position and engaged with a retention feature;

FIG. 71B depicts a partial plan view of the spent cartridge indicator ofFIG. 70 in the deployed position and disengaged from the retentionfeature;

FIG. 72 depicts a cross-sectional end view of another exemplaryalternative buttress applier cartridge, with a platform of the buttressapplier cartridge positioned in the end effector of FIG. 2;

FIG. 73 depicts a perspective view of an exemplary buttress appliercartridge that may be used to carry and apply the buttress assembly ofFIG. 5A;

FIG. 74 depicts a perspective view of a handle assembly of an exemplaryalternative surgical stapling instrument;

FIG. 75 depicts a perspective view of an end effector of the instrumentof FIG. 74, with the end effector in an open configuration;

FIG. 76 depicts a partial perspective view of the distal end of a staplecartridge of the end effector of FIG. 75, with a buttress assembly ofthe buttress applier cartridge of FIG. 73 engaging a deck of the staplecartridge;

FIG. 77 depicts a perspective view of the end effector of FIG. 75positioned to engage buttress assemblies of the buttress appliercartridge of FIG. 73;

FIG. 78 depicts a top plan view of a display of the handle assembly ofFIG. 74;

FIG. 79A depicts a cross-sectional side view of the buttress appliercartridge of FIG. 73, loaded with upper and lower buttress assemblies;

FIG. 79B depicts a cross-sectional side view of the buttress appliercartridge of FIG. 73, with the end effector of FIG. 75 clamped down onthe buttress assemblies;

FIG. 79C depicts a cross-sectional side view of the buttress appliercartridge of FIG. 73, with the upper and lower buttress assemblieshaving been removed by the end effector of FIG. 75;

FIG. 80 depicts a perspective view of an exemplary buttress assemblyapplier cartridge;

FIG. 81 depicts a partial perspective view of the cartridge of FIG. 80,with portions of the cartridge and buttress assembly cut away to revealinternal components;

FIG. 82 depicts an exploded perspective view of the buttress assemblyand associated mounting portions of the cartridge of FIG. 80;

FIG. 83A depicts a perspective view of an exemplary alternative buttressassembly applier cartridge loaded in a container, with a protective filmsecured to the container;

FIG. 83B depicts a perspective view of the cartridge and container ofFIG. 83A, with the protective film peeled away from the container;

FIG. 84 depicts a perspective view of an exemplary alternative buttressassembly with an integral protective film;

FIG. 85 depicts a cross-sectional end view of the buttress assembly ofFIG. 84;

FIG. 86A depicts a perspective view of an exemplary adhesive appliercartridge, with a protective film secured to the cartridge;

FIG. 86B depicts a perspective view of the cartridge of FIG. 86A, withthe protective film removed;

FIG. 87 depicts a cross-sectional end view of the cartridge of FIG. 86A;

FIG. 88 depicts a perspective view of the upper buttress and the lowerbuttress of FIG. 4 applied to the end effector of FIG. 2;

FIG. 89 depicts a perspective view of the upper buttress and the lowerbuttress of FIG. 4 applied to the end effector of FIG. 2 with a gap onthe upper buttress and the lower buttress for the longitudinallyextending channels of the end effector;

FIG. 90 depicts a partial perspective view of an exemplary multilayerbuttress body, with a portion of a layer broken away to reveal anotherlayer;

FIG. 91 depicts a side view of the multilayer buttress body of FIG. 90combined with an adhesive layer to form a multilayer buttress assemblyconfigured for use with the end effector of FIG. 2;

FIG. 92 depicts a side elevational view of another exemplary multilayerbuttress assembly configured for use with the end effector of FIG. 2;

FIG. 93 depicts a side elevational view of the multilayer buttressassembly of FIG. 92 without an adhesive layer and without a film layer;

FIG. 94A depicts a top plan view of the mesh layer of the multilayerbuttress of FIG. 92 in a relaxed position;

FIG. 94B depicts a top plan view of the mesh layer of the multilayerbuttress of FIG. 92 in a stretched position;

FIG. 95A depicts a top plan view of the film layer of the multilayerbuttress of FIG. 92 in a relaxed position;

FIG. 95B depicts a top plan view of the film layer of the multilayerbuttress of FIG. 92 in a stretched position;

FIG. 96 depicts a top plan view of an alternative example of a filmlayer that may be incorporated in the multilayer buttress of FIG. 92;

FIG. 97 depicts a top plan view of another alternative example of a filmlayer that may be incorporated in the multilayer buttress of FIG. 92;

FIG. 98 depicts a top plan view of another alternative example of a filmlayer that may be incorporated in the multilayer buttress of FIG. 92;

FIG. 99 depicts a partial cross-sectional view of an exemplary method ofusing a laser to form holes in the film layer of the multilayer buttressof FIG. 92;

FIG. 100 depicts a partial cross-sectional view of an exemplary methodof using a roller to form holes in the film layer of the multilayerbuttress of FIG. 92;

FIG. 101 depicts a partial cross-sectional view of an exemplary methodof using a press to form holes in the film layer of the multilayerbuttress of FIG. 92;

FIG. 102 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including an exemplary alternative buttressassembly;

FIG. 103 depicts a detailed perspective view of the staple cartridge andbuttress assembly of FIG. 102, showing retention features for releasablycoupling the buttress assembly to the staple cartridge;

FIG. 104A depicts a partial cross-sectional side view of the staplecartridge and buttress assembly of FIG. 102, showing the retentionfeatures coupling the buttress assembly to the staple cartridge;

FIG. 104B depicts a partial cross-sectional side view of the staplecartridge and buttress assembly of FIG. 102, showing the retentionfeatures having been decoupled to release the buttress assembly from thestaple cartridge;

FIG. 105 depicts a top plan view of a connector portion suitable forcoupling a buttress assembly to a staple cartridge;

FIG. 106 depicts a top plan view of an exemplary alternative buttressassembly;

FIG. 107 depicts a perspective view of an exemplary alternative staplecartridge incorporated into the lower jaw of end effector of instrumentof FIG. 1, showing the connector portion of FIG. 105 and the buttressassembly of FIG. 106;

FIG. 108 depicts a side elevational view of the staple cartridge of FIG.107, showing the buttress assembly of FIG. 106 being directed intoengagement with the connector portions of FIG. 105;

FIG. 109 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly and connector portion;

FIG. 110 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly and connector portion;

FIG. 111 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly and connector portion;

FIG. 112 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly and connector portion;

FIG. 113 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly and connector portion;

FIG. 114 depicts a top plan view of an exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 115 depicts a top plan view of an exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 116 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 117 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 118 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 119 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 120 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 121 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 122 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 123 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 124 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 125 depicts a top plan view of another exemplary alternative headportion suitable for incorporation into any of the connector portionsshown in FIGS. 105 and 107-113;

FIG. 126 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1,

FIG. 127 depicts a side elevational view of another exemplaryalternative buttress assembly;

FIG. 128 depicts a top plan view of the buttress assembly of FIG. 127;

FIG. 129 depicts a detailed top plan view showing an attachment featureof the buttress assembly of FIG. 127 having been engaged with the staplecartridge of FIG. 126;

FIG. 130 depicts a cross-sectional perspective view of an attachmentfeature of the buttress assembly of FIG. 127 having been engaged withthe staple cartridge of FIG. 126;

FIG. 131 depicts a cross-sectional end view showing the attachmentfeature of the buttress assembly of FIG. 127 having been engaged withthe staple cartridge of FIG. 126;

FIG. 132 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1;

FIG. 133 depicts a side elevational view of another exemplaryalternative buttress assembly;

FIG. 134 depicts a top plan view of the buttress assembly of FIG. 133;

FIG. 135 depicts a cross-sectional view, taken along line 135-135 ofFIG. 132, showing an attachment feature of the buttress assembly of FIG.133 having been engaged with the staple cartridge of FIG. 132;

FIG. 136 depicts a cross-sectional view, taken along line 136-136 ofFIG. 135, showing the attachment feature of the buttress assembly ofFIG. 133 having been engaged with the staple cartridge of FIG. 132;

FIG. 137 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1;

FIG. 138 depicts a side elevational view of another exemplaryalternative buttress assembly;

FIG. 139 depicts a top plan view of the buttress assembly of FIG. 138;

FIG. 140 depicts a cross-sectional perspective view, taken along line140-140 of FIG. 137, showing an attachment feature of the buttressassembly of FIG. 138 having been engaged with the staple cartridge ofFIG. 137;

FIG. 141 depicts a cross-sectional end view showing the attachmentfeature of the buttress assembly of FIG. 138 having been engaged withthe staple cartridge of FIG. 137;

FIG. 142 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly;

FIG. 143 depicts a perspective view of the proximal end of the staplecartridge of FIG. 142, showing an exemplary attachment feature of thebuttress assembly of FIG. 142;

FIG. 144 depicts a perspective view of the proximal end of the staplecartridge of FIG. 142, showing an exemplary attachment feature that maybe used with the buttress assembly of FIG. 142;

FIG. 145 depicts an end view of the proximal end of the staple cartridgeof FIG. 142, showing an exemplary attachment feature that may be usedwith the buttress assembly of FIG. 142;

FIG. 146 depicts a cross-sectional perspective view of the proximal endof the staple cartridge of FIG. 142 with the attachment feature of FIG.145;

FIG. 147 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly;

FIG. 148 depicts a partial perspective view of the proximal end of thebuttress assembly of FIG. 147;

FIG. 149A depicts a bottom plan view of retention features of thebuttress assembly of FIG. 147 engaged with a sled of the cartridge ofFIG. 147;

FIG. 149B depicts a bottom plan view of retention features of thebuttress assembly of FIG. 147, showing the sled having moved distallyand out of engagement with the retention features;

FIG. 150 depicts a partial perspective view of the proximal end ofanother exemplary alternative buttress assembly that may be applied tothe end effector of FIG. 2;

FIG. 151 depicts a partial top plan view of another exemplaryalternative buttress assembly that may be applied to the end effector ofFIG. 2;

FIG. 152 depicts a perspective view of the buttress assembly of FIG. 151after having been severed after actuation of the end effector FIG. 2;

FIG. 153 depicts a top plan view of another exemplary alternativebuttress assembly that may be applied to the end effector of FIG. 2,showing part of the buttress assembly having been severed afteractuation of the end effector;

FIG. 154 depicts a top plan view of another exemplary alternativebuttress assembly that may be applied to the end effector of FIG. 2;

FIG. 155 depicts a top plan view of another exemplary alternativebuttress assembly that may be applied to the end effector of FIG. 2;

FIG. 156 depicts a partial perspective view of another exemplaryalternative buttress assembly that may be applied to the end effector ofFIG. 2;

FIG. 157 depicts a top plan view of another exemplary alternativebuttress assembly that may be applied to the end effector of FIG. 2;

FIG. 158 depicts a top plan view of a connecting member that may beapplied to the end effector of FIG. 2 to connect two portions of abuttress assembly;

FIG. 159A depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of the end effector ofFIG. 2, including another exemplary alternative buttress assembly;

FIG. 159B depicts a perspective view of the staple cartridge of FIG.159A, showing the buttress assembly having been displaced from a channelof the cartridge by a knife member;

FIG. 160 depicts a perspective view of another exemplary alternativebuttress assembly that may be applied to the end effector of FIG. 2;

FIG. 161 depicts a cross-sectional end view of a portion of the endeffector of FIG. 2 with an exemplary alternative buttress assemblyapplied to the end effector;

FIG. 162A depicts a cross-sectional end view of a portion of thebuttress assembly of FIG. 161 applied to tissue with staples, with anend portion of the buttress assembly shown in a rolled configuration;

FIG. 162B depicts a cross-sectional end view of a portion of thebuttress assembly of FIG. 161 applied to tissue with staples, with theend portion of the buttress assembly shown in a unrolled configuration;

FIG. 163 depicts a cross-sectional end view of a portion of the endeffector of FIG. 2 with an exemplary alternative buttress assemblyapplied to the end effector;

FIG. 164 depicts a cross-sectional end view of a portion of the buttressassembly of FIG. 163 applied to tissue with staples;

FIG. 165 depicts a perspective view of another exemplary alternativestaple cartridge incorporated into the lower jaw of end effector ofinstrument of FIG. 1, including another exemplary alternative buttressassembly;

FIG. 166 depicts a top plan view of tissue severed and stapled multipletimes in succession using the cartridge and buttress assembly of FIG.165;

FIG. 167 depicts an enlarged schematic view of an exemplary planarfabric comprising woven fibers, suitable for incorporation into thebuttresses of FIG. 4;

FIG. 168 depicts two top plan views showing a buttress body in astretched state and the buttress body in a relaxed state;

FIG. 169 depicts an enlarged schematic view of an exemplary planarfabric comprising knitted fibers, suitable for incorporation into thebuttresses of FIG. 4;

FIG. 170 depicts an enlarged schematic view of an exemplary planarfabric comprising fibers knitted in a tricot pattern, suitable forincorporation into the buttresses of FIG. 4;

FIG. 171 depicts an enlarged schematic view of an exemplary planarfabric comprising fibers knitted in a weft insertion pattern, suitablefor incorporation into the buttresses of FIG. 4;

FIG. 172 depicts an enlarged schematic view of an exemplary planarfabric comprising fibers knitted in a weft pattern, suitable forincorporation into the buttresses of FIG. 4;

FIG. 173 depicts an enlarged schematic view of an exemplary planarfabric comprising knitted fibers, suitable for incorporation into thebuttresses of FIG. 4;

FIG. 174 depicts two top plan views showing a woven planar fabric in astretched state and the woven planar fabric in a relaxed state;

FIG. 175 depicts two top plan views showing a buttress body in astretched state and the buttress body in a relaxed state;

FIG. 176 depicts a perspective view of an exemplary alternativebuttress;

FIG. 177 depicts a cross-sectional end view of the buttress of FIG. 176;

FIG. 178 depicts a perspective view of another exemplary alternativebuttress;

FIG. 179 depicts a cross-sectional end view of the buttress of FIG. 177;

FIG. 180 depicts a perspective view of another exemplary upper buttressand an another exemplary lower buttress, each of which may be applied tothe end effector of FIG. 2;

FIG. 181 depicts a cross-sectional view of a staple and the upper andlower buttresses of FIG. 180 having been secured to the tissue by theend effector of FIG. 2;

FIG. 182 depicts a perspective view of another exemplary upper buttressand another exemplary lower buttress, each of which may be applied tothe end effector of FIG. 2;

FIG. 183 depicts a perspective view of an exemplary alternative buttressassembly;

FIG. 184 depicts a cross-sectional side view of another exemplaryalternative buttress assembly; and

FIG. 185 depicts a cross-sectional side view of another exemplaryalternative buttress assembly.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

I. EXEMPLARY SURGICAL STAPLER

FIG. 1 depicts an exemplary surgical stapling and severing instrument(10) that includes a handle assembly (20), a shaft assembly (30), and anend effector (40). End effector (40) and the distal portion of shaftassembly (30) are sized for insertion, in a nonarticulated state asdepicted in FIG. 1, through a trocar cannula to a surgical site in apatient for performing a surgical procedure. By way of example only,such a trocar may be inserted in a patient's abdomen, between two of thepatient's ribs, or elsewhere. In some settings, instrument (10) is usedwithout a trocar. For instance, end effector (40) and the distal portionof shaft assembly (30) may be inserted directly through a thoracotomy orother type of incision. It should be understood that terms such as“proximal” and “distal” are used herein with reference to a cliniciangripping handle assembly (20) of instrument (10). Thus, end effector(40) is distal with respect to the more proximal handle assembly (20).It will be further appreciated that for convenience and clarity, spatialterms such as “vertical” and “horizontal” are used herein with respectto the drawings. However, surgical instruments are used in manyorientations and positions, and these terms are not intended to belimiting and absolute.

A. Exemplary Handle Assembly and Shaft Assembly

As shown in FIG. 1, handle assembly (20) of the present examplecomprises pistol grip (22), a closure trigger (24), and a firing trigger(26). Each trigger (24, 26) is selectively pivotable toward and awayfrom pistol grip (22) as will be described in greater detail below.Handle assembly (20) further includes a removable battery pack (28).These components will also be described in greater detail below. Ofcourse, handle assembly (20) may have a variety of other components,features, and operabilities, in addition to or in lieu of any of thosenoted above. Other suitable configurations for handle assembly (20) willbe apparent to those of ordinary skill in the art in view of theteachings herein.

As shown in FIGS. 1-2, shaft assembly (30) of the present examplecomprises an outer closure tube (32), an articulation section (34), anda closure ring (36), which is further coupled with end effector (40).Closure tube (32) extends along the length of shaft assembly (30).Closure ring (36) is positioned distal to articulation section (34).Closure tube (32) and closure ring (36) are configured to translatelongitudinally relative to handle assembly (20). Longitudinaltranslation of closure tube (32) is communicated to closure ring (36)via articulation section (34). Exemplary features that may be used toprovide longitudinal translation of closure tube (32) and closure ring(36) will be described in greater detail below.

Articulation section (34) is operable to laterally deflect closure ring(36) and end effector (40) laterally away from the longitudinal axis(LA) of shaft assembly (30) at a desired angle (α). In the presentexample, articulation is controlled through an articulation control knob(35) which is located at the proximal end of shaft assembly (30).Closure ring (36) and end effector (40) pivot about an axis that isperpendicular to the longitudinal axis (LA) of shaft assembly (30) inresponse to rotation of knob (35). Articulation section (34) isconfigured to communicate longitudinal translation of closure tube (32)to closure ring (36), regardless of whether articulation section (34) isin a straight configuration or an articulated configuration. By way ofexample only, articulation section (34) and/or articulation control knob(35) may be constructed and operable in accordance with at least some ofthe teachings of U.S. Pub. No. 2014/0243801, entitled “SurgicalInstrument End Effector Articulation Drive with Pinion and OpposingRacks,” published Aug. 28, 2014, the disclosure of which is incorporatedby reference herein; and/or U.S. patent application Ser. No. 14/314,125,entitled “Articulation Drive Features for Surgical Stapler,” filed Jun.25, 2014, the disclosure of which is incorporated by reference herein;and/or in accordance with the various teachings below. Other suitableforms that articulation section (34) and articulation knob (35) may takewill be apparent to those of ordinary skill in the art in view of theteachings herein.

As shown in FIG. 1, shaft assembly (30) of the present example furtherincludes a rotation knob (31). Rotation knob (31) is operable to rotatethe entire shaft assembly (30) and end effector (40) relative to handleassembly (20) about the longitudinal axis (LA) of shaft assembly (30).Of course, shaft assembly (30) may have a variety of other components,features, and operabilities, in addition to or in lieu of any of thosenoted above. By way of example only, at least part of shaft assembly(30) is constructed in accordance with at least some of the teachings ofU.S. Pub. No. 2014/0239038, entitled “Surgical Instrument withMulti-Diameter Shaft,” published Aug. 28, 2014, the disclosure of whichis incorporated by reference herein. Other suitable configurations forshaft assembly (30) will be apparent to those of ordinary skill in theart in view of the teachings herein.

B. Exemplary End Effector

As also shown in FIGS. 1-3, end effector (40) of the present exampleincludes a lower jaw (50) and a pivotable anvil (60). Anvil (60)includes a pair of integral, outwardly extending pins (66) that aredisposed in corresponding curved slots (54) of lower jaw (50). Anvil(60) is pivotable toward and away from lower jaw (50) between an openposition (shown in FIG. 2) and a closed position (shown in FIG. 1). Useof the term “pivotable” (and similar terms with “pivot” as a base)should not be read as necessarily requiring pivotal movement about afixed axis. For instance, in the present example, anvil (60) pivotsabout an axis that is defined by pins (66), which slide along curvedslots (54) of lower jaw (50) as anvil (60) moves toward lower jaw (50).In such versions, the pivot axis translates along the path defined byslots (54) while anvil (60) simultaneously pivots about that axis. Inaddition or in the alternative, the pivot axis may slide along slots(54) first, with anvil (60) then pivoting about the pivot axis after thepivot axis has slid a certain distance along the slots (54). It shouldbe understood that such sliding/translating pivotal movement isencompassed within terms such as “pivot,” “pivots,” “pivotal,”“pivotable,” “pivoting,” and the like. Of course, some versions mayprovide pivotal movement of anvil (60) about an axis that remains fixedand does not translate within a slot or channel, etc.

As best seen in FIG. 3, lower jaw (50) of the present example defines achannel (52) that is configured to receive a staple cartridge (70).Staple cartridge (70) may be inserted into channel (52), end effector(40) may be actuated, and then staple cartridge (70) may be removed andreplaced with another staple cartridge (70). Lower jaw (50) thusreleasably retains staple cartridge (70) in alignment with anvil (60)for actuation of end effector (40). In some versions, lower jaw (50) isconstructed in accordance with at least some of the teachings of U.S.Pub. No. 2014/0239044, entitled “Installation Features for SurgicalInstrument End Effector Cartridge,” published Aug. 28, 2014, thedisclosure of which is incorporated by reference herein. Other suitableforms that lower jaw (50) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

As best seen in FIGS. 2-3, staple cartridge (70) of the present examplecomprises a cartridge body (71) and a tray (76) secured to the undersideof cartridge body (71). The upper side of cartridge body (71) presents adeck (73), against which tissue may be compressed when anvil (60) is ina closed position. Cartridge body (71) further defines a longitudinallyextending channel (72) and a plurality of staple pockets (74). A staple(90) is positioned in each staple pocket (74). A staple driver (75) isalso positioned in each staple pocket (74), underneath a correspondingstaple (90), and above tray (76). As will be described in greater detailbelow, staple drivers (75) are operable to translate upwardly in staplepockets (74) to thereby drive staples (90) upwardly through staplepockets (74) and into engagement with anvil (60). Staple drivers (75)are driven upwardly by a wedge sled (78), which is captured betweencartridge body (71) and tray (76), and which translates longitudinallythrough cartridge body (71).

Wedge sled (78) includes a pair of obliquely angled cam surfaces (79),which are configured to engage staple drivers (75) and thereby drivestaple drivers (75) upwardly as wedge sled (78) translateslongitudinally through cartridge (70). For instance, when wedge sled(78) is in a proximal position, staple drivers (75) are in downwardpositions and staples (90) are located in staple pockets (74). As wedgesled (78) is driven to the distal position by a translating knife member(80), wedge sled (78) drives staple drivers (75) upwardly, therebydriving staples (90) out of staple pockets (74) and into staple formingpockets (64) that are formed in the underside (65) of anvil (60). Thus,staple drivers (75) translate along a vertical dimension as wedge sled(78) translates along a horizontal dimension.

In some versions, staple cartridge (70) is constructed and operable inaccordance with at least some of the teachings of U. U.S. Pub. No.2014/0239042, entitled “Integrated Tissue Positioning and Jaw AlignmentFeatures for Surgical Stapler,” published Aug. 28, 2014, the disclosureof which is incorporated by reference herein. In addition or in thealternative, staple cartridge (70) may be constructed and operable inaccordance with at least some of the teachings of U.S. Pub. No.2014/0239044, entitled “Installation Features for Surgical InstrumentEnd Effector Cartridge,” published Aug. 28, 2014, the disclosure ofwhich is incorporated by reference herein. Other suitable forms thatstaple cartridge (70) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

As best seen in FIG. 2, anvil (60) of the present example comprises alongitudinally extending channel (62) and a plurality of staple formingpockets (64). Channel (62) is configured to align with channel (72) ofstaple cartridge (70) when anvil (60) is in a closed position. Eachstaple forming pocket (64) is positioned to lie over a correspondingstaple pocket (74) of staple cartridge (70) when anvil (60) is in aclosed position. Staple forming pockets (64) are configured to deformthe legs of staples (90) when staples (90) are driven through tissue andinto anvil (60). In particular, staple forming pockets (64) areconfigured to bend the legs of staples (90) to secure the formed staples(90) in the tissue. Anvil (60) may be constructed in accordance with atleast some of the teachings of U.S. Pub. No. 2014/0239042, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” published Aug. 28, 2014; at least some of the teachings ofU.S. Pub. No. 2014/0239036, entitled “Jaw Closure Feature for EndEffector of Surgical Instrument,” published Aug. 28, 2014; and/or atleast some of the teachings of U.S. Pub. No. 2014/0239037, entitled“Staple Forming Features for Surgical Stapling Instrument,” publishedAug. 28, 2014, the disclosure of which is incorporated by referenceherein. Other suitable forms that anvil (60) may take will be apparentto those of ordinary skill in the art in view of the teachings herein.

In the present example, a knife member (80) is configured to translatethrough end effector (40). As best seen in FIG. 3, knife member (80) issecured to the distal end of a firing beam (82), which extends through aportion of shaft assembly (30). As best seen in FIG. 2, knife member(80) is positioned in channels (62, 72) of anvil (60) and staplecartridge (70). Knife member (80) includes a distally presented cuttingedge (84) that is configured to sever tissue that is compressed betweenanvil (60) and deck (73) of staple cartridge (70) as knife member (80)translates distally through end effector (40). As noted above, knifemember (80) also drives wedge sled (78) distally as knife member (80)translates distally through end effector (40), thereby driving staples(90) through tissue and against anvil (60) into formation.

C. Exemplary Actuation of End Effector

In the present example, anvil (60) is driven toward lower jaw (50) byadvancing closure ring (36) distally relative to end effector (40).Closure ring (36) cooperates with anvil (60) through a camming action todrive anvil (60) toward lower jaw (50) in response to distal translationof closure ring (36) relative to end effector (40). Similarly, closurering (36) may cooperate with anvil (60) to open anvil (60) away fromlower jaw (50) in response to proximal translation of closure ring (36)relative to end effector (40). By way of example only, closure ring (36)and anvil (60) may interact in accordance with at least some of theteachings of U.S. Pub. No. 2014/0239036, entitled “Jaw Closure Featurefor End Effector of Surgical Instrument,” published Aug. 28, 2014, thedisclosure of which is incorporated by reference herein; and/or inaccordance with at least some of the teachings of U.S. patentapplication Ser. No. 14/314,108, entitled “Jaw Opening Feature forSurgical Stapler,” filed on Jun. 25, 2014, the disclosure of which isincorporated by reference herein.

As noted above, handle assembly (20) includes a pistol grip (22) and aclosure trigger (24). As also noted above, anvil (60) is closed towardlower jaw (50) in response to distal advancement of closure ring (36).In the present example, closure trigger (24) is pivotable toward pistolgrip (22) to drive closure tube (32) and closure ring (36) distally.Various suitable components that may be used to convert pivotal movementof closure trigger (24) toward pistol grip (22) into distal translationof closure tube (32) and closure ring (36) relative to handle assembly(20) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

Also in the present example, instrument (10) provides motorized controlof firing beam (82). In particular, instrument (10) includes motorizedcomponents that are configured to drive firing beam (82) distally inresponse to pivoting of firing trigger (26) toward pistol grip (22). Insome versions, a motor (not shown) is contained in pistol grip (22) andreceives power from battery pack (28). This motor is coupled with atransmission assembly (not shown) that converts rotary motion of a driveshaft of the motor into linear translation of firing beam (82). By wayof example only, the features that are operable to provide motorizedactuation of firing beam (82) may be configured and operable inaccordance with at least some of the teachings of U.S. Pat. No.8,210,411, entitled “Motor-Driven Surgical Instrument,” issued Jul. 3,2012, the disclosure of which is incorporated by reference herein; U.S.Pat. No. 8,453,914, entitled “Motor-Driven Surgical Cutting Instrumentwith Electric Actuator Directional Control Assembly,” issued Jun. 4,2013, the disclosure of which is incorporated by reference herein;and/or U.S. patent application Ser. No. 14/226,142, entitled “SurgicalInstrument Comprising a Sensor System,” filed Mar. 26, 2014, thedisclosure of which is incorporated by reference herein.

It should also be understood that any other components or features ofinstrument (10) may be configured and operable in accordance with any ofthe various references cited herein. Additional exemplary modificationsthat may be provided for instrument (10) will be described in greaterdetail below. Various suitable ways in which the below teachings may beincorporated into instrument (10) will be apparent to those of ordinaryskill in the art. Similarly, various suitable ways in which the belowteachings may be combined with various teachings of the references citedherein will be apparent to those of ordinary skill in the art. It shouldtherefore be understood that the teachings below may be readilyincorporated into the various instruments taught in the variousreferences that are cited herein. It should also be understood that thebelow teachings are not limited to instrument (10) or devices taught inthe references cited herein. The below teachings may be readily appliedto various other kinds of instruments, including instruments that wouldnot be classified as surgical staplers. Various other suitable devicesand settings in which the below teachings may be applied will beapparent to those of ordinary skill in the art in view of the teachingsherein.

II. EXEMPLARY BUTTRESS ASSEMBLY FOR SURGICAL STAPLER

In some instances, it may be desirable to equip end effector (40) with abuttress material to reinforce the mechanical fastening of tissueprovided by staples (90). Such a buttress may prevent the appliedstaples (90) from pulling through the tissue and may otherwise reduce arisk of tissue tearing at or near the site of applied staples (90). Inaddition to or as an alternative to providing structural support andintegrity to a line of staples (90), a buttress may provide variousother kinds of effects such as spacing or gap-filling, administration oftherapeutic agents, and/or other effects. In some instances, a buttressmay be provided on deck (73) of staple cartridge (70). In some otherinstances, a buttress may be provided on the surface of anvil (60) thatfaces staple cartridge (70). It should also be understood that a firstbuttress may be provided on deck (73) of staple cartridge (70) while asecond buttress is provided on anvil (60) of the same end effector (40).Various examples of forms that a buttress may take will be described ingreater detail below. Various ways in which a buttress may be secured toa staple cartridge (70) or an anvil (60) will also be described ingreater detail below.

A. Exemplary Composition of Buttress Assembly for Surgical Stapler

FIG. 4 shows an exemplary pair of buttress assemblies (100, 110) with abasic composition. Buttress assembly (100) of this example comprises abuttress body (102) and an upper adhesive layer (104). Similarly,buttress assembly (110) comprises a buttress body (112) and a loweradhesive layer (114). In the present example, each buttress body (102,112) comprises a strong yet flexible material configured to structurallysupport a line of staples (90). By way of example only, each buttressbody (102, 112) may comprise a mesh of polyglactin 910 material byEthicon, Inc. of Somerville, N.J. Alternatively, any other suitablematerials or combinations of materials may be used in addition to or asan alternative to polyglactin 910 material to form each buttress body(102, 112). Each buttress body (102, 112) may take any other suitableform and may be constructed of any other suitable material(s). By way offurther example only, each buttress body (102, 112) may comprise one ormore of the following: NEOVEIL absorbable PGA felt by Gunze Limited, ofKyoto, Japan; SEAMGUARD polyglycolic acid:trimethylene carbonate(PGA:TMC) reinforcement material by W.L. Gore & Associates, Inc., ofFlagstaff, Ariz.; PERI-STRIPS DRY with VERITAS Collagen Matrix (PSDV)reinforcement material, by Baxter Healthcare Corporation of Deerfield,Ill.; BIODESIGN biologic graft material by Cook Medical, Bloomington,Ind.; and/or SURGICEL NU-KNIT hemostat material by Ethicon, Inc. ofSomerville, N.J. Still other suitable materials that may be used to formeach buttress body (102, 112) will be apparent to those of ordinaryskill in the art in view of the teachings herein.

In addition or in the alternative, each buttress body (102, 112) maycomprise a material including, for example, a hemostatic agent such asfibrin to assist in coagulating blood and reduce bleeding at the severedand/or stapled surgical site along tissue (90). As another merelyillustrative example, each buttress body (102, 112) may comprise otheradjuncts or hemostatic agents such as thrombin may be used such thateach buttress body (102, 112) may assist to coagulate blood and reducethe amount of bleeding at the surgical site. Other adjuncts or reagentsthat may be incorporated into each buttress body (102, 112) may furtherinclude but are not limited to medical fluid or matrix components.Merely illustrative examples of materials that may be used to form eachbuttress body (102, 112), as well as materials that may be otherwiseincorporated into each buttress body (102, 112), are disclosed in U.S.patent application Ser. No. 14/667,842, entitled “Method of Applying aButtress to a Surgical Stapler,” filed Mar. 25, 2015, the disclosure ofwhich is incorporated by reference herein. Alternatively, any othersuitable materials may be used.

By way of further example only, each buttress body (102, 112) may beconstructed in accordance with at least some of the teachings of U.S.Patent Pub. No. 2012/0241493, entitled “Tissue Thickness CompensatorComprising Controlled Release and Expansion,” published Sep. 27, 2012,the disclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0068816, entitled “Surgical Instrument and ButtressMaterial,” published Mar. 21, 2013, the disclosure of which isincorporated by reference herein; U.S. Patent Pub. No. 2013/0062391,entitled “Surgical Instrument with Fluid Fillable Buttress,” publishedMar. 14, 2013, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0068820, entitled “Fibrin Pad Matrixwith Suspended Heat Activated Beads of Adhesive,” published Mar. 21,2013, the disclosure of which is incorporated by reference herein; U.S.Patent Pub. No. 2013/0082086, entitled “Attachment of Surgical StapleButtress to Cartridge,” published Apr. 4, 2013, the disclosure of whichis incorporated by reference herein; U.S. Patent Pub. No. 2013/0037596,entitled “Device for Applying Adjunct in Endoscopic Procedure,”published Feb. 14, 2013, the disclosure of which is incorporated byreference herein; U.S. Patent Pub. No. 2013/0062393, entitled “ResistiveHeated Surgical Staple Cartridge with Phase Change Sealant,” publishedMar. 14, 2013, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0075446, entitled “Surgical StapleAssembly with Hemostatic Feature,” published Mar. 28, 2013, thedisclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0062394, entitled “Surgical Staple Cartridge withSelf-Dispensing Staple Buttress,” published Mar. 14, 2013, thedisclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0075445, entitled “Anvil Cartridge for Surgical FasteningDevice,” published Mar. 28, 2013, the disclosure of which isincorporated by reference herein; U.S. Patent Pub. No. 2013/0075447,entitled “Adjunct Therapy for Applying Hemostatic Agent,” published Mar.28, 2013, the disclosure of which is incorporated by reference herein;U.S. Patent Pub. No. 2013/0256367, entitled “Tissue ThicknessCompensator Comprising a Plurality of Medicaments,” published Oct. 3,2013, the disclosure of which is incorporated by reference herein; U.S.patent application Ser. No. 14/300,954, entitled “Adjunct Materials andMethods of Using Same in Surgical Methods for Tissue Sealing,” filedJun. 10, 2014, the disclosure of which is incorporated by referenceherein; U.S. patent application Ser. No. 14/827,856, entitled“Implantable Layers for a Surgical Instrument,” filed Aug. 17, 2015, thedisclosure of which is incorporated by reference herein; U.S. patentapplication Ser. No. 14/840,613, entitled “Drug Eluting Adjuncts andMethods of Using Drug Eluting Adjuncts,” filed Aug. 31, 2015, thedisclosure of which is incorporated by reference herein; U.S. patentapplication Ser. No. 14/871,071, entitled “Compressible Adjunct withCrossing Spacer Fibers,” filed Sep. 30, 2015, the disclosure of which isincorporated by reference herein; and/or U.S. patent application Ser.No. 14/871,131, entitled “Method for Applying an Implantable Layer to aFastener Cartridge,” filed Sep. 30, 2015, the disclosure of which isincorporated by reference herein.

In the present example, adhesive layer (104) is provided on buttressbody (102) in order to adhere buttress body (102) to underside (65) ofanvil (60). Similarly, adhesive layer (114) is provided on buttress body(112) in order to adhere buttress body (112) to deck (73) of staplecartridge (70). Adherence of the buttress body (102) to underside (65)of anvil (60) or to deck (73) of staple cartridge (70) can occur througha variety of mechanisms including but not limited to a pressuresensitive adhesive. In some versions, each adhesive layer (104, 114)comprise a pressure sensitive adhesive material. Examples of varioussuitable materials that may be used to form adhesive layers (104, 114)are disclosed in U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, the disclosure of which is incorporated by reference herein.Alternatively, any other suitable materials may be used. It should beunderstood that the term “adhesive,” as used herein, may include (but isnot limited to) tacky materials and also materials that are pliable orwax-like and adhere to a complex geometry via deformation andconformance. Some suitable adhesives may provide such pliability toadhere to a complex geometry via deformation and conformance withoutnecessarily providing a high initial tack. In some instances, adhesiveswith lower tackiness may be removed more cleanly from surfaces. Varioussuitable materials that may be used to form adhesive layers (104, 114)will be apparent to those of ordinary skill in the art in view of theteachings herein.

B. Exemplary Materials and Techniques for Providing Adhesion of Buttressto Surgical Stapler

As noted above, a buttress assembly (100, 110) may include a layer (104,114) of adhesive material (or other form of adhesive material) thatadheres buttress body (102, 112) to either underside (65) of anvil (60)or deck (73) of staple cartridge (70). Such an adhesive material mayprovide proper positioning of buttress body (102, 112) before and duringactuation of end effector (40); then allow buttress body (102, 112) toseparate from end effector (40) after end effector (40) has beenactuated, without causing damage to buttress body (102, 112) that issubstantial enough to compromise the proper subsequent functioning ofbuttress body (102, 112).

FIGS. 5A-5C show a sequence where an end effector (40) that has beenloaded with buttress assemblies (100, 110) is actuated to drive staples(90) through two apposed layers of tissue (T₁, T₂), with buttressassemblies (100, 110) being secured to the same layers of tissue (T₁,T₂) by staples (90). In particular, FIG. 5A shows layers of tissue (T₁,T₂) positioned between anvil (60) and staple cartridge (70), with anvil(60) in the open position. Buttress assembly (100) is adhered to theunderside (65) of anvil (60) via adhesive layer (104); while buttressassembly (110) is adhered to deck (73) of staple cartridge (70) viaadhesive layer (114). Layers of tissue (T₁, T₂) are thus interposedbetween buttress assemblies (100, 110). Next, trigger (24) is pivotedtoward pistol grip (22) to drive closure tube (32) and closure ring (36)distally. This drives anvil (60) to the closed position as shown in FIG.5B. At this stage, layers of tissue (T₁, T₂) are compressed betweenanvil (60) and staple cartridge (70), with buttress assemblies (100,110) engaging opposite surfaces of tissue layers (T₁, T₂). End effector(40) is then actuated as described above, driving staple (90) throughbuttress assemblies (100, 110) and tissue (90). As shown in FIG. 5C,crown (92) of driven staple (90) captures and retains buttress assembly(110) against layer of tissue (T₂). Deformed legs (94) of staple (90)capture and retain buttress assembly (100) against layer of tissue (T₁).

It should be understood that a series of staples (90) will similarlycapture and retain buttress assemblies (100, 110) against layers oftissue (T₁, T₂), thereby securing buttress assemblies (100, 110) totissue (T₁, T₂) as shown in FIG. 6. As end effector (40) is pulled awayfrom tissue (90) after deploying staples (90) and buttress assemblies(100, 110), buttress assemblies (100, 110) disengage end effector), suchthat buttress assemblies (100, 110) remain secured to tissue (T₁, T₂)with staples (90). Buttress tissue (T₁, T₂) thus provide structuralreinforcement to the lines of staples (90). As can also be seen in FIG.6, knife member (80) also cuts through a centerline of buttress tissueassemblies (100, 110), separating each buttress assemblies (100, 110)into a corresponding pair of sections, such that each section remainssecured to a respective severed region of tissue (T₁, T₂).

In the foregoing example, buttress assembly (100) is sized to spanacross the full width of underside (65), such that buttress assembly(100) spans across channel (62). Thus, knife member (80) cuts throughbuttress assembly (100) during actuation of end effector (40) asdescribed above. In some other examples, such as those described below,buttress assembly (100) is provided in two separate, laterally spacedapart portions, with one portion being disposed on underside (65) on oneside of channel (62) and another portion being disposed on underside(65) on the other side of channel (62). In such versions, buttressassembly (100) does not span across channel (62), such that knife member(80) does not cut through buttress assembly (100) during actuation ofend effector (40).

Likewise, buttress assembly (110) may be sized to span across the fullwidth of deck (73), such that buttress assembly (110) spans acrosschannel (72), and such that knife member (80) cuts through buttressassembly (110) during actuation of end effector (40) as described above.Alternatively, buttress assembly (110) may be provided in two separate,laterally spaced apart portions, with one portion being disposed on deck(73) on one side of channel (72) and another portion being disposed ondeck (73) on the other side of channel (72), such that buttress assembly(110) does not span across channel (72), and such that knife member (80)does not cut through buttress assembly (110) during actuation of endeffector (40).

In addition to the foregoing, it should also be understood that any ofthe various buttress assemblies described herein may be furtherconstructed and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, the disclosure of which is incorporated by reference herein.

III. Exemplary Buttress Applier Cartridges

As noted above, buttress assembly (100) may be applied to the underside(65) of anvil (60), and buttress (110) may be applied to deck (73) ofstaple cartridge (70), before tissue (T₁, T₂) is positioned in endeffector (40), and before end effector (40) is actuated. Because endeffector (40) may be actuated many times during use of instrument (10)in a single surgical procedure, it may be desirable to enable anoperator to repeatedly and easily load buttress assemblies (100) onunderside (65) of anvil (60) during that single surgical procedure. Inother words, because end effector (40) may be actuated many times duringuse of instrument (10) in a single surgical procedure, it may beinsufficient to simply provide anvil (60) pre-loaded with a buttressassembly (100) without facilitating the re-loading of anvil (60) withadditional buttress assemblies (100) after end effector (40) has beenactuated.

Similarly, those of ordinary skill in the art will recognize that staplecartridge (70) will need to be replaced each time end effector (40) isactuated. When end effector (40) is actuated several times during use ofinstrument (10) in a single surgical procedure, several staplecartridges (70) may thus be used during that surgical procedure. It mayseem that each of these staple cartridges (70) may be provided withbuttress assembly (110) pre-loaded on deck (73). However, there are somereasons why it may be undesirable to provide a staple cartridge (70)with buttress assembly (110) pre-loaded on deck (73). In other words, itmay be desirable to provide loading of buttress assembly (110) on deck(73) immediately prior to usage of staple cartridge in the surgicalprocedure, rather than loading buttress assembly (110) on deck (73) asubstantial time prior to the surgical procedure. For instance, buttressassembly (110) may not be compatible with the same sterilizationtechniques as staple cartridge (70), such that it may present processingdifficulties to package staple cartridge (70) with buttress assembly(110) pre-loaded on deck (73). In addition, the material formingbuttress assembly (110) may have certain environmental sensitivitiesthat staple cartridge (70) does not have, such that it may be beneficialto enable buttress assembly (110) and staple cartridge (70) to be storedseparately before use. Moreover, buttress assembly (110) may not bewarranted or otherwise desired in some surgical procedures, such that itmay be desirable to enable a physician to easily choose whether staplecartridge (70) should be loaded with buttress assembly (110) before thatstaple cartridge (70) is used in the surgical procedure.

In view of the foregoing, it may be desirable to enable an operator torepeatedly and easily load buttress assemblies (100, 110) on endeffector (40) on an ad hoc basis during a given surgical procedure. Itmay also be desirable to provide a device that provides support andprotection to buttress assemblies (100, 110) before buttress assemblies(100, 110) are loaded on end effector (40), in addition to that samedevice also enabling buttress assemblies (100, 110) to be easily loadedon end effector. The examples described below relate to variouscartridge assemblies that provide such support, protection, and loadingof buttress assemblies (100, 110). It should be understood that thefollowing examples are merely illustrative. Numerous variations will beapparent to those of ordinary skill in the art in view of the teachingsherein.

A. Exemplary Buttress Applier Cartridge with Active Retainer Arms

FIGS. 7-17B show an exemplary buttress applier cartridge (200) that maybe used to support and protect buttress assemblies (100, 110). Cartridge(200) may also be used to easily load buttress assemblies (100, 110) onend effector (40). As best seen in FIGS. 7-8, cartridge (200) of thisexample comprises an open end (202) and a closed end (204). Open end(202) is configured to receive end effector (40) as will be described ingreater detail below. Cartridge (200) further includes a first housing(210) and a second housing (218), which each generally define a “U”shape to present open end (202). As best seen in FIG. 9, variouscomponents are interposed between housings (210, 218). In particular,these components include a platform (220), a pair of actuator sleds(240), a pair of retainers (250), a chassis (260), and a sled retainer(280). Each of these components will be described in greater detailbelow.

Platform (220) of the present example is configured to support a pair ofbuttress assemblies (100) on one side of platform (220) and another pairof buttress assemblies (110) on the other side of platform (220).Platform (220) is exposed in recesses that are formed between the prongsof the “U” configuration of housings (210, 218). The location ofplatform (220) and buttress assemblies (100, 110) in such recesses mayprevent inadvertent contact between buttress assemblies (100, 110) andother devices in the operating room. In other words, housings (210, 218)may provide some degree of physical shielding of buttress assemblies(100, 110).

In the present example, each buttress assembly (100, 110) is provided ina respective pair of portions that are separated to avoid spanningacross channels (62, 72) of anvil (60) and staple cartridge (70),respectively, though it should be understood that platform (220) mayjust as easily support wide versions of buttress assemblies (100, 110)that unitarily span across channels (62, 72) of anvil (60) and staplecartridge (70), respectively. The outer edges of platform (220) arecaptured between housings (210, 218) and include retention features(222) in the form of ridges that further engage housings (210, 218) toprevent platform (220) from sliding relative to housings (210, 218). Insome versions, platform (220) is formed of a material that provides ahigh coefficient of friction, thereby reducing any tendency thatbuttress assemblies (100, 110) might otherwise have to slide alongcorresponding surfaces of platform (220). For instance, platform (220)may comprise an elastomeric material and/or a foam material. In someinstances, platform (220) is formed of a compressible foam material thatis configured to maintain a compressed configuration after beingcompressed by end effector (40). By way of example only, platform (220)may comprise Santoprene, closed-cell polyurethane foam, any othercompressible material, and/or a material that may be made compressiblevia geometry (e.g., a rubber material with deformable standingfeatures). Various suitable materials and structural configurations thatmay be used to form platform (220) will be apparent to those of ordinaryskill in the art in view of the teachings herein.

Chassis (260) is configured to cooperate with housings (210, 218) toprovide a mechanical ground for moving components of cartridge (200) andprovide structural support for components of cartridge (200). As shownin FIGS. 7-8, chassis (260) includes integral gripping features (262)that are exposed on opposite sides of housings (210, 218). Grippingfeatures (262) have a surface geometry that is configured to promote anoperator's grip of cartridge (200) during use of cartridge (200).Various suitable configurations that may be used for gripping features(262) will be apparent to those of ordinary skill in the art in view ofthe teachings herein. Similarly, various surface treatments (e.g.,elastomeric material, etc.) that may be applied to gripping features(262) will be apparent to those of ordinary skill in the art in view ofthe teachings herein. As best seen in FIG. 11, chassis (260) furtherincludes a set of laterally oriented slots (264), a first pair of bosses(266), and a second pair of bosses (268). Slots (264) are configured toslidably receive pins (296) as shown in FIGS. 9 and 15A-15B. Inparticular, pins (296) may translate laterally within slots (264) (i.e.toward and away from the central longitudinal axis extending along thecenter of platform (220)). In the present example, there are six slots(264) and only four pins (296), such that two of the slots (264) are notused. In other versions, there are six pins (296) such that all sixslots (264) are used. In still other versions, there are only four slots(264), corresponding with the four pins (296) of the present example.

Actuator sleds (240) are slidably positioned on opposite faces ofchassis (260). As shown in FIG. 12, each actuator sled includes alocking recess (241), a set of slots (244), and a pair of boss features(249). As shown in FIG. 9, a set of coil springs (298) are positionedbetween bosses (266) of chassis (260) and boss features (249) ofactuator sled (240). Coil springs (298) resiliently bias actuator sleds(240) proximally relative to chassis (260). As will be described ingreater detail below, locking recess (241) is configured to selectivelyengage a locking ridge (286) of sled retainer (280) to selectively lockthe longitudinal position of actuator sleds (240) relative to chassis(260), thereby resisting the resilient bias of coil springs (298). Asshown in FIGS. 9 and 15A-15B, an indicator plate (242) is secured to theproximal end of each actuator sled (240), such that indicator plates(242) will translate unitarily with actuator sleds (240). Indicatorplates (242) are positioned to correspond with windows (212) that areformed in housings (210, 218), such that indicator plates (242) arevisible through windows (212) when actuator sleds (240) are in a distalposition and when actuator sleds (240) are in a proximal position. Aswill be described in greater detail below, indicator plates (242) mayinclude different colored regions or other markings that provide visualindication through windows (212), visually indicating whether actuatorsleds (240) are in the distal position or the proximal position.

As shown in FIGS. 9 and 15A-15B, slots (244) are positioned to alsoreceive pins (296). Each slot (244) includes a longitudinally extendingportion (246) and an obliquely extending portion (248). Pins (296) areconfigured to travel along the longitudinally extending portion (246) ofeach corresponding slot (244) and along the obliquely extending portion(248) of each corresponding slot (244). In the present example, thereare six slots (244) and only four pins (296), such that two of the slots(244) are not used. In other versions, there are six pins (296) suchthat all six slots (244) are used. In still other versions, there areonly four slots (244), corresponding with the four pins (296) of thepresent example.

Retainers (250) are slidably disposed on respective actuator sleds(240), such that each actuator sled (240) is slidably interposed betweenchassis (260) and a corresponding retainer (250). As shown in FIG. 13,each retainer (250) includes a set of arms (252) and a set of openings(254). Openings (254) are positioned to receive pins (296). Pins (296)are secured within openings (254) such that pins (296) do not movewithin corresponding openings (254). Retainers (250) thus travelunitarily with pins (296) in this example, as will be described ingreater detail below. In the present example, there are six openings(254) and only four pins (296), such that two of the openings (254) arenot used. In other versions, there are six pins (296) such that all sixopenings (254) are used. In still other versions, there are only fouropenings (254), corresponding with the four pins (296) of the presentexample.

Arms (252) of the present example are configured to selectively securebuttress assemblies (100, 110) to platform (220). In particular, FIGS.7-8, 14A, and 15A show retainers (250) positioned such that buttressassemblies (100, 110) are interposed between the free ends of arms (252)and platform (220). As described in greater detail below, retainers(250) are movable laterally outwardly such that arms (252) disengagebuttress assemblies (100, 110), thereby enabling buttress assemblies(100, 110) to be removed from platform (220). In the present example,arms (252) are resilient and are thus configured to resiliently bearagainst buttress assemblies (100, 110), thereby pinching buttressassemblies (100, 110) against platform (220). Other suitable ways inwhich arms (252) may engage buttress assemblies (100, 110) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

As shown in FIG. 10, sled retainer (280) includes a pair of arms (281)that together generally define a “U” shape. The free end of each arm(281) includes a tapered cam surface (282) and a housing engagementfeature (284). As best seen in FIGS. 8 and 14A-14B, housing engagementfeatures (284) are positioned to engage corresponding surfaces ofhousings (210, 218). Each arm (281) further includes a respectivelocking ridge (286) spaced proximally from the corresponding housingengagement feature (284). Sled retainer (280) further defines a channel(288) in the region where arms (281) meet each other. As shown in FIG.9, channel (288) is configured to receive the proximal end of chassis(260).

FIGS. 14A-17B show cartridge (200) in different stages of operation. Inparticular, FIGS. 14A, 15A, and 17A show cartridge (200) in aconfiguration where retainer arms (252) are positioned to hold buttressassemblies (100, 110) against platform (220); while FIGS. 14B, 15B, and17B show cartridge (200) in a configuration where retainer arms (252)are positioned to release buttress assemblies (100, 110) from platform(220). While FIGS. 14A-17B only show buttress assembly (100) on platform(220), it should be understood that buttress assembly (110) would beretained on and released from platform (220) in an identical fashion.

To use cartridge (200) to load end effector (40), the operator wouldfirst position cartridge (200) and end effector (40) such that endeffector is aligned with open end (202) of cartridge (200) as shown inFIG. 16A. The operator would then advance end effector (40) distally(and/or retract cartridge (200) proximally) to position platform (220)and buttress assemblies (100, 110) between anvil (60) and staplecartridge (70) as shown in FIG. 16B. This will ultimately result in thearrangement shown in FIG. 17A. While end effector (40) is not shown inFIG. 14A or 15A, it should be understood that cartridge (200) is in thesame state in FIG. 17A as the state shown in FIGS. 14A and 15A. In thisstate, actuator sleds (240) are in a first longitudinal position (i.e.,closer to open end (202)). Coil springs (298) are resiliently urgingactuator sleds (240) toward a second longitudinal position (i.e., closerto closed end (204)). However, as best seen in FIG. 17A, locking ridges(286) of sled retainer (280) are disposed in locking recesses (241) ofactuator sleds (240), thereby holding actuator sleds (240) in the firstlongitudinal position. With actuator sleds (240) in the firstlongitudinal position, retainers (250) are located at inward positionsto retain buttress assemblies (100, 110) against platform (220). Asshown in FIG. 15A, at this stage, pins (296) are positioned at the innerends of slots (264) of chassis (260); and in the ends of obliquelyextending portions (248) of slots (244).

In order to load buttress assemblies (100, 110) on end effector (40),the operator may simply close end effector (40) by pivoting anvil (60)toward staple cartridge (70), as described above, to reach the stateshown in FIG. 17B. As shown, closure of end effector (40) results in thedistal ends of anvil (60) and staple cartridge (70) bearing against camsurfaces (282) of sled retainer (280). This causes arms (281) of sledretainer to deform toward each other, such that locking ridges (286)disengage locking recesses (241) of actuator sleds (240). With lockingridges (286) disengaged from locking recesses (241) of actuator sleds(240), coil springs (298) drive actuator sleds (240) proximally to thesecond longitudinal position. Actuator sleds (240) engage bosses (268)of chassis (260) when actuator sleds (240) reach the proximal position,such that bosses (268) provide a hard stop. It should be understood thatthis sudden engagement between actuator sleds (240) and bosses (268) mayproduce a click or snap sound, providing audible feedback to theoperator indicating actuation of cartridge (200).

In the present example, cartridge (200) is configured such that botharms (281) must be deformed toward each other at the same time in orderfor actuator sleds (240) to be unlocked and thereby permitted totranslate proximally to the second longitudinal position. If only onearm (281) is deformed toward the other arm (281), the locking ridge(286) of the non-deformed arm (281) will remain disposed in thecorresponding locking recess (241) of actuator sled (240), therebycontinuing to hold actuator sled (240) in the first longitudinalposition. By requiring both arms (281) to be deformed toward each otherat the same time in order for actuator sleds (240) to be unlocked, theconfiguration of sled retainer (280) will reduce the risk of cartridge(200) being actuated prematurely or inadvertently.

As best seen in the transition from the view shown in FIG. 15A (actuatorsleds (240) in the first longitudinal position) to the view shown inFIG. 15B (actuator sleds (240) in the second longitudinal position),slots (244) act as cams against pins (296) and thereby drive retainers(250) outwardly as actuator sleds (240) travel proximally. Inparticular, pins (296) traverse obliquely extending portions (248) ofslots (244) and then longitudinally extending portions (246) of slots(244). Obliquely extending portions (248) of slots (244) drive pins(296) outwardly during this range of travel. Since retainers (250)travel unitarily with pins (296), retainers (250) travel outwardly aswell. Laterally oriented slots (264) of chassis (260) accommodate theoutward lateral movement of pins (296) but prevent pins (296) frommoving longitudinally during the transition from the state shown in FIG.15A to the state shown in FIG. 15B.

Upon reaching the state shown in FIG. 15B, retainers (250) aredisengaged from buttress assemblies (100, 110). This state is also shownin FIG. 14B. It should be understood that end effector (40) is still inthe closed configuration at this stage, as also shown in FIG. 17B. Thus,with end effector (40) clamping on both buttress assemblies (100, 110),adhesive layers (104, 114) are adhered to underside (65) of anvil (60)and deck (73) of staple cartridge (70). End effector (40) may then bere-opened (i.e., pivoting anvil (60) away from staple cartridge (70))and pulled away from cartridge (200). With retainers (250) disengagedfrom buttress assemblies (100, 110), end effector (40) may freely pullbuttress assemblies (100, 110) away from platform (220) as end effector(40) is pulled away from cartridge (200). With buttress assemblies (100,110) loaded on end effector (40), end effector (40) may then be used asdescribed above with reference to FIGS. 5A-6.

Referring back to FIGS. 7-8, housings (210, 218) of the present exampleinclude proximal guide features (214) and distal guide features (216).Guide features (214, 216) are configured to assist in providing properalignment of end effector (40) with cartridge (200). In particular,guide features (214, 216) are configured to engage the lateral sides oflower jaw (50) and anvil (60) to ensure that the central longitudinalaxis of end effector (40) is coplanar with the central longitudinal axisof platform (220). Such alignment will prevent buttress assemblies (100,110) from being applied to underside (65) or deck (73) in a skewedorientation. In some versions, guide features (214, 216) engage thelateral sides of lower jaw (50) and anvil (60) as soon as end effector(40) is positioned as shown in FIG. 16B (i.e., before anvil (60) ispivoted to the closed position). In some other versions, guide features(214, 216) do not engage the lateral sides of lower jaw (50) and anvil(60) until anvil (60) is pivoted closer to the closed position. In thepresent example, guide features (214, 216) are unitarily formed featuresof housings (210, 218). In some other versions, guide features (214,216) are movable relative to housings (210, 218) and are resilientlybiased to provide self-centering guidance to the lateral sides of lowerjaw (50) and anvil (60). Various suitable forms that guide features(214, 216) may take will be apparent to those of ordinary skill in theart in view of the teachings herein.

As noted above, indicator plates (242) may include different coloredregions or other markings (e.g., text, pictograms, etc.) that providevisual indication through windows (212), visually indicating whetheractuator sleds (240) are in the first longitudinal position (FIG. 15A)or the second longitudinal position (FIG. 15B). The operator may thusview indicator plate (242) through window (212) to determine whethercartridge (200) has successfully released buttress assemblies (100,110). An operator may also view indicator plate (242) through window(212) to determine whether cartridge (200) has been previously used.Various suitable markings that may be provided on indicator plates (242)to provide visual feedback indicating the state of cartridge (200) willbe apparent to those of ordinary skill in the art in view of theteachings herein.

B. Exemplary Buttress Applier Cartridge with Passive Retainer Arms

FIGS. 18-19 show another exemplary buttress applier cartridge (300) thatmay be used to support and protect buttress assemblies (100, 110).Cartridge (300) may also be used to easily load buttress assemblies(100, 110) on end effector (40). As best seen in FIG. 18, cartridge(300) of this example comprises an open end (302) and a closed end(304). Open end (302) is configured to receive end effector (40) asdescribed above. Cartridge (300) further includes a first housing (310)and a second housing (318), which each generally define a “U” shape topresent open end (302). As best seen in FIG. 19, various components areinterposed between housings (310, 318). In particular, these componentsinclude a platform (320), a pair of retainers (350), and a chassis(360). Each of these components will be described in greater detailbelow.

Housings (310, 318) are configured substantially identically to housings(210, 218) described above. For instance, housings (310, 318) includeguide features (314, 316) just like guide features (214, 216) describedabove. However, housings (310, 318) lack windows (212). Platform (320)of this example is identical to platform (220) described above,including the presence of retention features (322) in the form of ridgesthat further engage housings (310, 318) to prevent platform (320) fromsliding relative to housings (310, 318). Chassis (360) is also identicalto chassis (260), including the presence of integral gripping features(362) like gripping features (262) described above. Chassis (360) alsoincludes laterally oriented slots just like slots (264) of chassis(260).

Retainers (350) are substantially similar to retainers (250). Retainers(350) are coupled together via pins (396), which are slidably disposedin the laterally oriented slots of chassis (360). Pins (396) providecoordinated lateral movement of retainers (350). In particular, theretainers (350) that are coupled together via pins (396) will movelaterally in unison with each other. Retainers (350) include resilientretention arms (352). Arms (352) are similar to arms (252) in that arms(352) will effectively pinch buttress assemblies (100, 110) againstplatform (320) with a resilient bias.

When cartridge (300) is positioned relative to end effector (40) in anarrangement similar to that shown in FIG. 16B, and then end effector(40) is closed about platform (320) to reach an arrangement similar tothat shown in FIG. 17B, anvil (60) and staple cartridge (70) will bearagainst corresponding surfaces of arms (352) and thereby cause arms(352) to slide laterally outwardly. Arms (352) will thus disengagebuttress assemblies (100, 110) and thereby release buttress assemblies(100, 110) from platform (320). Underside (65) of anvil (60) will pressagainst adhesive layer (104) of buttress assembly (100) and therebyadhere buttress assembly (100) to anvil (60). Similarly, deck (73) ofstaple cartridge (70) will press against adhesive layer (114) ofbuttress assembly (110) and thereby adhere buttress assembly (110) tostaple cartridge (70). With buttress assemblies (100, 110) released fromplatform (320) and adhered to end effector (40), end effector (40) maybe transitioned back to the open configuration and pulled away fromcartridge (300). End effector (40) may then be used in a surgicalprocedure with buttress assemblies (100, 110) loaded thereon.

It should be understood that retainers (350) may remain located atlaterally outward positions after releasing buttress assemblies (100,110) from platform (320). For instance, the free ends of arms (352) maybe bearing into corresponding surfaces of platform (320) providingfriction that substantially maintains the positioning of retainers (350)relative to platform (320). An operator may visually observe thelaterally outward positioning of retainers (350) and may therebyconclude that cartridge (300) has released buttress assemblies (100,110). Alternatively, cartridge (300) may include various other kinds offeatures to provide visual feedback (and/or other feedback) indicatingthe state of cartridge (300).

In some alternative versions, arms (352) deform outwardly (instead ofsliding outwardly) in order to release buttress assemblies (100, 110) inresponse to closure of end effector (40) about platform (320). In stillother versions, arms (352) do not deform or translate outwardly inresponse to closure of end effector (40) about platform (320). Instead,the adhesion resulting from engagement between underside (65) of anvil(60) with adhesive surface (104) of buttress assembly (100), and theadhesion resulting from engagement between deck (73) of staple cartridge(73) with adhesive surface (114) of buttress assembly (110), willprovide a secure engagement between buttress assemblies (100, 110) andend effector (40). This adhesive engagement may be secure enough toenable end effector (40) to pull buttress assemblies (100, 110) awayfrom the free ends of arms (352) without damaging buttress assemblies(100, 110) or otherwise compromising the positioning of buttressassemblies (100, 110) on end effector (40), while arms (352) maintainthe configuration and positioning shown in FIG. 18.

C. Exemplary Buttress Applier Cartridge with Passive Retaining HousingFeatures

FIGS. 20-23 show another exemplary buttress applier cartridge (400) thatmay be used to support and protect buttress assemblies (100, 110).Cartridge (400) may also be used to easily load buttress assemblies(100, 110) on end effector (40). As best seen in FIG. 20-21, cartridge(400) of this example comprises an open end (402) and a closed end(404). Open end (402) is configured to receive end effector (40) asdescribed above. Cartridge (400) further includes a first housing (410)and a second housing (418), which each generally define a “U” shape topresent open end (402). As best seen in FIG. 22, a platform (420) isinterposed between housings (410, 418).

Each housing (410, 418) of the present example comprises an integralretention fin (452). Fins (452) extend longitudinally along substantialportions of the lengths of corresponding buttress assemblies (100, 110).As best seen in FIG. 23, retention fins (452) of housing (410) securebuttress assembly (100) to platform (420); while retention fins (452) ofhousing (418) secure buttress assembly (110) to platform (420). At leasta portion of each housing (410, 418) may comprise a resilient materialsuch that retention fins (452) resiliently bear against correspondingbuttress assemblies (100, 110). In addition or in the alternative,platform (420) may comprise a resilient material that is biased toexpand outwardly, such that platform (420) bears buttress assemblies(100, 110) against corresponding retention fins (452). Various suitablematerials that may be used to form housings (410, 418) and platform(420) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

When cartridge (400) is positioned relative to end effector (40) in anarrangement similar to that shown in FIG. 16B, and then end effector(40) is closed about platform (420) to reach an arrangement similar tothat shown in FIG. 17B, anvil (60) and staple cartridge (70) will bearagainst corresponding surfaces of retention fins (452) and thereby causeretention fins (452) to deform laterally outwardly. Retention fins (452)will thus disengage buttress assemblies (100, 110) and thereby releasebuttress assemblies (100, 110) from platform (420). Underside (65) ofanvil (60) will press against adhesive layer (104) of buttress assembly(100) and thereby adhere buttress assembly (100) to anvil (60).Similarly, deck (73) of staple cartridge (70) will press againstadhesive layer (114) of buttress assembly (110) and thereby adherebuttress assembly (110) to staple cartridge (70). With buttressassemblies (100, 110) released from platform (420) and adhered to endeffector (40), end effector (40) may be transitioned back to the openconfiguration and pulled away from cartridge (400). End effector (40)may then be used in a surgical procedure with buttress assemblies (100,110) loaded thereon.

In some other versions, retention fins (452) do not deform or translateoutwardly in response to closure of end effector (40) about platform(320). Instead, the adhesion resulting from engagement between underside(65) of anvil (60) with adhesive surface (104) of buttress assembly(100), and the adhesion resulting from engagement between deck (73) ofstaple cartridge (73) with adhesive surface (114) of buttress assembly(110), will provide a secure engagement between buttress assemblies(100, 110) and end effector (40). This adhesive engagement may be secureenough to enable end effector (40) to pull buttress assemblies (100,110) away from retention fins (452) without damaging buttress assemblies(100, 110) or otherwise compromising the positioning of buttressassemblies (100, 110) on end effector (40), while retention fins (452)maintain the configuration and positioning shown in FIGS. 20-21 and 23.

IV. EXEMPLARY ALTERNATIVE PLATFORMS FOR BUTTRESS APPLIER CARTRIDGES

In the examples above, platforms (220, 320, 420) are provided asgenerally flat, stationary members that simply provide support tobuttress assemblies (100, 110) until buttress assemblies (100, 110) areadhered to end effector (40). It may be desirable to provide additionalfunctionality to platform (220, 320, 420). For instance, it may bedesirable to enable platform (220, 320, 420) to slide relative tohousings (210, 218, 310, 318, 410, 418). For instance, when the operatorclamps down on buttress assemblies (100, 110) and platform (220, 320,420) with end effector (40), the operator may wish to pull platform(220, 320, 420) toward the operator, through open end (202, 302, 402),with end effector (40) still clamped down on buttress assemblies (100,110) and platform (220, 320, 420). This may further promote removal ofbuttress assemblies (100, 110) from platform (220, 320, 420) and/orenable the operator to more readily confirm visually that buttressassemblies (100, 110) have been removed from platform (220, 320, 420).Several merely illustrative variations of platform (220, 320, 420) willbe described in greater detail below. Further variations will beapparent to those of ordinary skill in the art in view of the teachingsherein.

FIG. 24 shows an exemplary alternative buttress applier cartridge (500)that may be used to support and protect buttress assemblies (100, 110).Cartridge (500) may also be used to easily load buttress assemblies(100, 110) on end effector (40). Cartridge (500) of this exampleincludes a housing (510) and a platform (520). Housing (510) of thepresent example comprises a pair of longitudinally extending retentionfins (552) that are configured to releasably secure buttress assemblies(100, 110) to platform (520) just like retention fins (452) describedabove. It should be understood that fins (552) are provided by way ofexample only; and that cartridge (500) may instead include any othersuitable kinds of buttress assembly (100, 110) retention features,including but not limited to those described elsewhere herein.

Platform (520) of the present example includes a longitudinallyprojecting tongue (522) and a pair of outwardly extending tabs (524).Tongue (522) is located at one end of platform (520) while tabs (524)are located at the other end of platform (520). While buttressassemblies (100, 110) are not shown in FIG. 24, it should be understoodthat platform (520) may receive and hold buttress assemblies (100, 110)just like platforms (220, 320, 420) described above.

In the present example, platform (520) is configured to slidelongitudinally relative to housing (510). In particular, when anoperator clamps down on buttress assemblies (100, 110) and platform(520) with end effector (40), the operator may pull platform (520)toward the operator, with end effector (40) still clamped down onbuttress assemblies (100, 110) and platform (520) until platform (520)is translated to the position shown in FIG. 24. At this stage, tabs(524) engage the end of housing (510) and thereby prevent platform (520)from translating further. The operator may then release platform (520)by transitioning end effector (40) back to the open position, carryingaway buttress assemblies (100, 110) on end effector (40).

In the present example, fins (552) cooperate to slightly compressplatform (520), providing friction that prevents platform (520) frominadvertently translating to the advanced position shown in FIG. 24.However, the compression exerted by fins (552) on platform (520) stillenables platform (520) to be pulled to the advanced position shown inFIG. 24, as described above, without tearing platform (520). It shouldalso be understood that the friction provided by fins (552) againstplatform (520) may substantially hold platform (520) in the advancedposition shown in FIG. 24.

It may be desirable to rely on more than just friction to hold a slidingplatform in an advanced position. FIGS. 25A-25B show another exemplaryalternative buttress applier cartridge (550) that may be used to supportand protect buttress assemblies (100, 110) on a platform (570) that maybe secured in an advanced position. Cartridge (550) may also be used toeasily load buttress assemblies (100, 110) on end effector (40).Cartridge (550) of this example includes a housing (560) and platform(570). While not shown, cartridge (550) may include retention finsand/or any other suitable kinds of buttress assembly (100, 110)retention features, including but not limited to those describedelsewhere herein.

Platform (570) of the present example includes a longitudinallyprojecting tongue (572), a pair of outwardly extending tabs (574), and apair of outwardly extending locking pawls (576). Tongue (572) is locatedat one end of platform (570) while tabs (574) are located at the otherend of platform (570). While buttress assemblies (100, 110) are notshown in FIGS. 25A-25B, it should be understood that platform (570) mayreceive and hold buttress assemblies (100, 110) just like platforms(220, 320, 420) described above.

In the present example, platform (570) is configured to slidelongitudinally relative to housing (510). In particular, when anoperator clamps down on buttress assemblies (100, 110) and platform(570) with end effector (40), the operator may pull platform (570)toward the operator, with end effector (40) still clamped down onbuttress assemblies (100, 110) and platform (570) until platform (570)is translated from the position shown in FIG. 25A to the position shownin FIG. 25B. At this stage, tabs (574) engage inwardly extending bosses(562) of housing (560), which thereby prevent platform (570) fromtranslating further. In addition, pawls (576) engage bosses (562) toprevent platform (570) from translating back to the retracted position.It should be understood that pawls (576) may deform inwardly as platform(570) translates from the position shown in FIG. 25A to the positionshown in FIG. 25B. Once platform (570) has reached the position shown inFIG. 25B, the operator may then release platform (570) by transitioningend effector (40) back to the open position, carrying away buttressassemblies (100, 110) on end effector (40).

It should be understood that either of the slidable platforms (520, 570)described above may be readily incorporated into any of the cartridges(200, 300, 400) described above.

V. EXEMPLARY ALTERNATIVE BUTTRESS RETENTION FEATURES FOR BUTTRESSAPPLIER CARTRIDGES

As described above, a cartridge (200, 300, 400) may secure buttressassemblies (100, 110) to platform (220, 320, 420) using arms (252, 352)or fins (452). However, it will be understood that arms (252, 352) andfins (452) are merely illustrative examples of structures that may beused to secure buttress assemblies (100, 110) to platform (220, 320,420). Several additional structures that may be used to secure buttressassemblies (100, 110) to platform (220, 320, 420) will be described ingreater detail below, while still further examples will be apparent tothose of ordinary skill in the art in view of the teachings herein. Itshould be understood that the following teachings may be readilyincorporated into any of the various buttress applier cartridgesdescribed herein.

A. Exemplary Buttress Applier Cartridge with Ratcheting Retaining Arms

FIGS. 26A-26C show another exemplary buttress applier cartridge (900)that may be used to support and protect buttress assemblies (100, 110).Cartridge (900) may also be used to easily load buttress assemblies(100, 110) on end effector (40). Cartridge (900) of this exampleincludes housings (910, 918) and a platform (920). Platform (920) ofthis example is substantially identical to platforms (220, 320, 420)described above, except that platform (920) of this example includesrigid lateral edges (922) extending along the length of eachlongitudinally extending side of platform (920). Cartridge (900) of thisexample further includes ratcheting retainer arms (952). Arms (952) ofthis example are substantially similar to arms (352) of cartridge (300).However, unlike arms (352), arms (952) include ratcheting teeth (954) asbest seen in FIGS. 27A-27B. Ratcheting teeth (954) are configured toengage rigid lateral edges (922) of platform (920) to hold arms (952) ina releasing position as described below.

FIGS. 26A and 27A show cartridge (900) in a state prior to engagementwith end effector (40). At this stage, the free ends of arms (952)engage the lateral edges of buttress assemblies (100, 110) and therebysecure buttress assemblies (100, 110) to platform (920). In particular,the lateral edges of buttress assemblies (100, 110) are captured betweenthe free ends of arms (952) and rigid lateral edges (922) of platform(920). In the present example, arms (952) are resiliently biased to bearagainst buttress assemblies (100, 110) to maintain this engagement andthereby secure buttress assemblies (100, 110) to platform (920).

FIGS. 26B and 27B show cartridge (900) as end effector (40) is clampingdown on buttress assemblies (100, 110) and platform (920). As shown, thelateral edges of anvil (60) and staple cartridge (70) engage arms (952),thereby urging the upper set of arms (952) toward the lower set of arms(952). The resulting movement of arms (952) causes arms (952) to moveoutwardly away from buttress assemblies (100, 110), thereby disengagingbuttress assemblies (100, 110). In addition, as best seen in FIG. 27B,this movement of arms (952) causes teeth (954) of arms (952) to ratchetalong rigid lateral edges (922) of platform (920). As best seen in FIG.26B, the intermediate region of platform (920) compresses while edges(922) of platform (920) do not compress during closure of end effector.This difference in compressibility across the width of platform (920)enables edges (922) to further urge the lateral edges of buttressassemblies (100, 110) into adhesive engagement with the chamferedlateral edges of anvil (60) and staple cartridge (70).

FIG. 26C shows cartridge (900) released from end effector (40). Asshown, buttress assemblies (100, 110) are adhered to anvil (60) andstaple cartridge (70), such that end effector (40) is ready for use in asurgical procedure as described above. In addition, arms (952) remainsecured in a releasing position due to the engagement between teeth(954) of arms (952) with rigid lateral edges (922) of platform (920).

B. Exemplary Buttress Applier Cartridge with Multi-Buttress Layers

In some instances, it may be desirable to enable a single buttressapplier cartridge to be used to apply several layers of buttressassemblies (100, 110) to an end effector (40) during a single surgicalprocedure. In other words, it may be desirable to enable an operator touse a cartridge to apply a first set of buttress assemblies (100, 110)to an end effector (40), use the end effector (40) to apply staples (90)and that first set of buttress assemblies (100, 110) to tissue, then usethe same cartridge to apply a second set of buttress assemblies (100,110) to the same end effector (40) (after staple cartridge (70) has beenreplaced), then use the same end effector (40) to apply staples (90) andthat second set of buttress assemblies (100, 110) to tissue, and so on.

FIGS. 28-29 show one merely illustrative way in which a single buttressapplier cartridge to be used to apply several layers of buttressassemblies (100, 110) to an end effector (40) during a single surgicalprocedure. In particular, FIG. 28 shows an exemplary buttress appliercartridge (1000) that may be used to support and protect buttressassemblies (100, 110, 120, 130, 140, 150). Cartridge (1000) may also beused to easily load buttress assemblies (100, 110, 120, 130, 140, 150)on end effector (40). Cartridge (1000) of this example includes housings(1010, 1018), a platform (1020), and retainer arms (1052). Platform(1020) of this example is substantially identical to platforms (220,320, 420) described above. Arms (1052) of this example are substantiallysimilar to arms (352) of cartridge (300).

Cartridge (1000) of the present example differs from other buttressapplier cartridges described herein in that cartridge (1000) includesseveral layers of buttress assemblies (100, 110, 120, 130, 140, 150) oneach side of platform (1020). In particular, cartridge (1000) includethree layers of buttress assemblies (100, 120, 140) on the upper surfaceof platform (1020); and three layers of buttress assemblies (110, 130,150) on the lower surface of platform (1020). Buttress assemblies (100,120, 140) are thus configured and positioned to engage underside (65) ofanvil (50); while buttress assemblies (110, 130, 150) are configured andpositioned to engage deck (73) of staple cartridge (70). In the presentexample, buttress assemblies (100, 120, 140) have a progressivelyincreasing lateral width, such that the uppermost buttress assembly(100) has the narrowest width, the intermediate buttress assembly (120)has an intermediate width, and the lowermost buttress assembly (140) hasthe widest width. Similarly, buttress assemblies (110, 130, 150) have aprogressively increasing lateral width, such that the lowermost buttressassembly (110) has the narrowest width, the intermediate buttressassembly (130) has an intermediate width, and the uppermost buttressassembly (150) has the widest width.

Arms (1052) are resiliently biased to bear against buttress assemblies(100, 110, 120, 130, 140, 150) to thereby secure buttress assemblies(100, 110, 120, 130, 140, 150) to platform (1020). When end effector(40) is clamped down on buttress assemblies (100, 110, 120, 130, 140,150) and platform (1020) a first time, the lateral edges of anvil (60)and staple cartridge (70) engage arms (1052), thereby urging the upperset of arms (1052) toward the lower set of arms (1052). This causes arms(1052) to disengage buttress assemblies (100, 110) and directly engagebuttress assemblies (120, 130); while buttress assemblies (100, 110) areadhered to anvil (60) and staple cartridge (70), respectively. When endeffector (40) is subsequently opened, buttress assemblies (100, 110)remain adhered to anvil (60) and staple cartridge (70) and are thuspulled away from cartridge (1000), while buttress assemblies (120, 130,140, 150) remain secured to platform (1020).

When end effector (40) is then clamped down on buttress assemblies (120,130, 140, 150) and platform (1020) a second time (e.g., after endeffector (40) has been actuated on tissue and reloaded with a new staplecartridge (70)), the lateral edges of anvil (60) and staple cartridge(70) engage arms (1052) again, thereby urging the upper set of arms(1052) toward the lower set of arms (1052) again. This causes arms(1052) to disengage buttress assemblies (120, 130) and directly engagebuttress assemblies (140, 150); while buttress assemblies (120, 130) areadhered to anvil (60) and staple cartridge (70), respectively. When endeffector (40) is subsequently opened, buttress assemblies (120, 130)remain adhered to anvil (60) and staple cartridge (70) and are thuspulled away from cartridge (1000), while buttress assemblies (140, 150)remain secured to platform (1020).

When end effector (40) is then clamped down on buttress assemblies (140,150) and platform (1020) a third time (e.g., after end effector (40) hasbeen actuated on tissue and reloaded with a new staple cartridge (70)),the lateral edges of anvil (60) and staple cartridge (70) engage arms(1052) again, thereby urging the upper set of arms (1052) toward thelower set of arms (1052) again. This causes arms (1052) to disengagebuttress assemblies (140, 150) and directly engage platform (1020);while buttress assemblies (140, 150) are adhered to anvil (60) andstaple cartridge (70), respectively. When end effector (40) issubsequently opened, buttress assemblies (140, 150) remain adhered toanvil (60) and staple cartridge (70) and are thus pulled away fromcartridge (1000).

It should be understood from the foregoing that the varying widths ofbuttress assemblies (100, 110, 120, 130, 140, 150) enable arms (1052) toengage corresponding sets of buttress assemblies (100, 110, 120, 130,140, 150) in a succession each time end effector (40) is closed uponbuttress assemblies (100, 110, 120, 130, 140, 150) and platform (1020).This succession is best seen in FIG. 29. It should also be understoodthat any other suitable number of layers of buttress assemblies (100,110, 120, 130, 140, 150) may be used.

VI. EXEMPLARY ALTERNATIVE STAPLE CARTRIDGE WITH INTEGRAL BUTTRESS

In the examples described above, a buttress assembly (110) is applied toa staple cartridge (70) by using a buttress applying cartridge rightbefore end effector (40) will be actuated in a surgical procedure. Insome instances, it may be desirable to provide a staple cartridge (70)that includes a buttress assembly (110) that is pre-loaded on deck(730). Such a pre-loaded buttress assembly (110) may be providedregardless of whether or not a buttress applying cartridge will be usedto apply a buttress assembly (100) to underside (65) of anvil (60) rightbefore end effector (40) will be actuated in a surgical procedure.

FIG. 30 shows an exemplary cartridge assembly (1200) that includes amodified staple cartridge (1270) pre-loaded with a buttress assembly(170). Staple cartridge (1270) of this example is substantiallyidentical to staple cartridge (70) described above except that staplecartridge (1270) includes a pair of laterally extending engagement wings(1280) extending along the lateral sides of deck (1273). Wings (1280)define suture slots (1282) that are configured to receive correspondingstrands of suture (172) as will be described below. Buttress assembly(170) includes a body (171) that is substantially identical to body(112) of buttress assembly (110) described above. In the presentexample, buttress assembly (170) lacks an adhesive layer like adhesivelayer (114). In some other versions, buttress assembly (170) includes anadhesive layer to assist in securing buttress assembly (170) to deck(1273) of staple cartridge (1270).

In the present example, suture (172) is used to releasably securebuttress assembly (170) to staple cartridge (1270). Cartridge assembly(1200) includes two strands of suture (172), each strand being locatedat a respective lateral side of cartridge assembly (1200). As shown inFIG. 30 and FIG. 32A, each strand of suture (172) is woven through body(171) and suture slots (1282) of a corresponding wing (1280). The freeend (174) of each suture (172) is positioned at the distal end of body(171) while the other end of each suture (172) is secured to wedge sled(1278) of staple cartridge (1270). Wedge sled (1278) of this example isconfigured and operable just like wedge sled (78) of staple cartridge(70).

Cartridge assembly (1200) may be loaded in lower jaw (50) just likestaple cartridge (70), with buttress assembly (170) already secured tostaple cartridge (1270). When staple cartridge (1270) is actuated todrive staples (90) through tissue as described above with respect tostaple cartridge (70), wedge sled (1278) and suture (172) will cooperateto release buttress assembly (170) from staple cartridge (1270). Inparticular, as shown in FIG. 32B, wedge sled (1278) will pull suture(172) distally when wedge sled (1278) is driven distally as end effector(40) is actuated. Suture (172) will thus be pulled through body (171)and suture slots (1282) of wing (1280). In the present example, suture(172) has a length such that free end (174) of suture (172) will bepulled free of buttress assembly (170) when wedge sled (1278) reaches adistal-most position in response to full actuation of end effector (40).In some versions, suture (172) has a length such that free end (174) ofsuture (172) will be pulled into the interior of staple cartridge (1270)when wedge sled (1278) reaches a distal-most position in response tofull actuation of end effector (40).

FIG. 31 shows another exemplary cartridge assembly (1250) that is amerely illustrative variation of cartridge assembly (1200) describedabove. Cartridge assembly (1200) of this example comprises the samestaple cartridge (1270) pre-loaded with a different buttress assembly(190). Buttress assembly (190) includes a body (191) that issubstantially identical to body (112) of buttress assembly (110)described above. Suture (192) is used to secure body (191) to staplecartridge (1270) in the same manner in which suture (172) is used tosecure body (171) to staple cartridge (1270). In the present example,buttress assembly (190) lacks an adhesive layer like adhesive layer(114). In some other versions, buttress assembly (190) includes anadhesive layer to assist in securing buttress assembly (190) to deck(1273) of staple cartridge (1270). The difference between buttressassembly (190) and buttress assembly (170) is that buttress assembly(190) includes outwardly extending wing portions (194). Otherwise,buttress assembly (190) is secured to and released from staple cartridge(1270) just like buttress assembly (170) as shown in FIGS. 32A-32B. Itshould be understood that wing portions (194) may assist with tissueingrowth and/or other buttress anchoring properties. In addition or inthe alternative, wing portions (194) may provide a smooth transitionfrom the relatively thick, uncompressed region of tissue to therelatively thin, compressed tissue where formed staples (90) are in thetissue. In some versions, wing portions (194) are formed with a weavedensity that is different from (i.e., greater than or lesser than) theweave density of the remainder of buttress assembly (190).

VII. EXEMPLARY CUTTING BUTTRESS RELEASING FEATURES FOR BUTTRESS APPLIERCARTRIDGE

In the foregoing examples that include buttress applier cartridges, theentire body (102, 112) of each buttress assembly (100, 110) is fullyreleased from the buttress applier cartridge after an end effector (40)has been closed and opened to apply buttress assemblies (100, 110) toend effector (40). In some instances, it may be desirable to have thebuttress applier cartridge retain a first portion of the body of thebuttress assembly, even after a second portion of the buttress assemblyhas been applied to an end effector (40). To that end, FIG. 33 shows anexemplary alternative buttress applier cartridge (1300) that may be usedto support and protect upper and lower buttress assemblies (1330).Cartridge (1300) may also be used to easily load upper and lowerbuttress assemblies (1330) on end effector (40). Cartridge (1300) ofthis example includes an open end (1302) and a closed end (1304) definedby upper and lower housings (1310, 1318). Cartridge (1300) furtherincludes and a platform (1320) supporting a pair of buttress assemblies(1330). Buttress assemblies (1330) are releasably secured to cartridge(1300) by a set of retainers (1350).

FIG. 34 shows buttress assembly (1330) in greater detail. Buttressassembly (1130) includes an inner body portion (1332) and an outer bodyportion (1334) that are joined together by a set of bridge portions(1336) in the form of webs. An adhesive layer (1338) is positioned oninner body portion (1332) but not outer body portion (1334). Thematerial composition of body portions (1332, 1334) and adhesive layer(1338) may be the same for that described above with respect to bodyportion (102, 112) and adhesive layer (104, 114), respectively. Innerbody portion (1332) is rectangular and is sized and configured tocorrespond with the gap defined laterally between the prongs (1311) ofhousing (1310), which is the same as the gap defined laterally betweenthe prongs (1319) of housing (1318). It should be understood that thesize and configuration of this gap also corresponds to the clampingfootprint of end effector (40). Outer body portion (1334) has a “U”shape and is sized and configured to fit within the hollow interiordefined between housings (1310, 1318). Outer body portion (1334)includes a set of openings that are sized and positioned to receivecorresponding posts of housings (1310, 1318), to thereby secure thepositioning of outer body portion (1334) between housings (1310, 1318).

Bridge portions (1336) of buttress assembly (1330) are sized andpositioned to correspond with retainers (1350). As best seen in FIGS.50A-50B, each retainer (1350) comprises a buttress engagement foot(1352), an integral blade (1354), a cam surface (1356), and ratchetteeth (1358). Foot (1352) is rounded in this example and is configuredto press bridge portion (1336) against platform (1320), therebyassisting in holding the position of buttress assembly (1330) onplatform (1320). Blade (1354) projects downwardly and is configured tosever bridge portion (1336) as will be described in greater detailbelow. Cam surface (1356) is configured to engage anvil (60) duringclosure of end effector (40) as will also be described in greater detailbelow. While the present example is provided in the context ofengagement with anvil (60), it should be understood that cam surfaces(1356) of retainers (1350) on the underside of platform (1320) wouldsimilarly engage staple cartridge (70) during closure of end effector(40). Ratchet teeth (1358) are positioned and configured to engage afixed pawl (1312). Fixed pawl (1312) is unitary with (or is otherwisefixedly secured to) housing (1310, 1318).

In the state shown in FIG. 35A, teeth (1358) cooperate with pawl (1312)to maintain a vertical position of retainer (1350) where foot (1352) ispressing bridge portion (1336) against platform (1320). Blade (1354) isspaced away from bridge portion (1336). As end effector (40) is closedabout buttress assemblies (1330) and platform (1320), the lateral edgeof anvil (60) engages cam surface (1356) and thereby drives retainer(1350) downwardly to the position shown in FIG. 35B. Platform (1320) isformed of a compliant material in this example, such that platform(1320) accommodates the additional pressing of foot (1352) into platform(1320). As retainer (1350) is driven downwardly, blade (1354) seversbridge portion (1336), thereby decoupling inner body portion (1332) fromouter body portion (1334). Inner body portion (1332) is thus free to bepulled away from platform (1320). Adhesive layer (1338) adheres innerbody portion (1332) to underside (65) of anvil (60), such that anvil(60) will freely pull inner body portion (1332) away from cartridge(1300) as end effector (40) is subsequently opened. Teeth (1358) againcooperate with pawl (1312) to maintain the lowered vertical position ofretainer (1350). It should be understood that teeth (1358) will ratchetalong pawl (1312) during the transition from the state shown in FIG. 35Ato the state shown in FIG. 35B.

VIII. EXEMPLARY END EFFECTOR ALIGNMENT FEATURES FOR BUTTRESS APPLIERCARTRIDGE

In some instances, it may be desirable to configure buttress assembly(100) such that the lateral width of buttress assembly (100) closelymatches the lateral width of underside (65) of anvil (60). Likewise, itmay be desirable to configure buttress assembly (110) such that thelateral width of buttress assembly (110) closely matches the lateralwidth of deck (73) of anvil (70). Matching these widths may presentlittle to no margin of error with respect to alignment of end effector(40) with buttress assemblies (100, 110). It may therefore be desirableto provide features that ensure or otherwise promote proper alignment ofend effector (40) with buttress assemblies (100, 110). Such alignmentmay include proper lateral positioning of end effector along a lateralplane (i.e., a plane that is parallel to the planes defined by buttressassemblies (100, 110)). Such alignment may also include proper “yaw”positioning about an axis that is perpendicular to the same lateralplane (i.e., a plane that is parallel to the planes defined by buttressassemblies (100, 110)). Several examples of features that may be used toensure or otherwise promote proper alignment of end effector (40) withbuttress assemblies (100, 110) are described in greater detail below,while other examples will be apparent to those of ordinary skill in theart in view of the teachings herein.

In addition to or as an alternative to providing visual cues to promoteproper alignment between end effector (40) and a buttress appliercartridge, it may be desirable to incorporate structural features in abuttress applier cartridge to ensure proper alignment. A few merelyillustrative examples of structural guide features are described ingreater detail below, while other examples will be apparent to those ofordinary skill in the art in view of the teachings herein.

Those of ordinary skill in the art will further recognize that surgicalstapling and severing instruments (10) may come in a variety of sizes,including different sizes with end effectors (40) having differentlateral widths. It may therefore be desirable to enable a buttressapplier cartridge to be used with end effectors (40) having differentlateral widths. Moreover, it may be desirable for such a buttressapplier cartridge to also provide proper lateral alignment betweenbuttress assemblies (100, 110) and end effectors (40) having differentlateral widths. To that end, FIGS. 54A-54B show an exemplary buttressapplier cartridge (1600) that is configured to accommodate a relativelynarrow anvil (60) and a relatively wide anvil (1660). While FIGS.54A-54B only show an upper portion of cartridge (1600) associated withanvils (60, 1660), it should be understood that cartridge (1600) mayhave a similarly configured lower portion that is associated with staplecartridges (70) and lower jaws (50) of different widths.

Cartridge (1600) of the present example comprises a housing (1610), aplatform (1620), a first retention feature (1640), a second retentionfeature (1650), a pinion (1670), and a resilient member (1680). Platform(1620) supports buttress assembly (100) just like various otherplatforms described herein. Retention feature (1640) comprises aretention arm (1642) and an integral rack (1644). Retention feature(1650) also comprises a retention arm (1652) and an integral rack(1654). While just two retention features (1640, 1650) are shown inFIGS. 54A-54B, it should be understood that several additional retentionfeatures (1640, 1650) may be positioned along the length of cartridge(1600). Racks (1644, 1654) are engaged with pinion (1670), which isrotatably supported in housing (1610). Racks (1644, 1654) are engagedwith pinion (1670) at regions of pinion (1670) that are angularly offsetby 180 degrees. Thus, racks (1644, 1654) will translate simultaneouslyin opposing directions as pinion (1670) rotates. Resilient member (1680)is positioned between retention feature (1650) and housing (1610). Inthe present example, resilient member (1680) is in the form of a coilspring that urges retention features (1640, 1650) toward each other.

Arms (1642, 1652) are configured to bear against buttress assembly (100)to thereby secure buttress assembly (100) against platform (1620). Arms(1642, 1652) are also angled to cooperate with outer lateral edges ofanvil (60, 1660) as anvil (60, 1660) is clamped down toward buttressassembly (100) and platform (1620). In particular, as anvil (60, 1660)is clamped down toward buttress assembly (100) and platform (1620), theouter edges outer lateral edges of anvil (60, 1660) will engage angledsurfaces of arms (1642, 1652), which will drive arms (1642, 1652)outwardly. Because arms (1642, 1652) are coupled together via racks(1644, 1654) and pinion (1670), arms (1642, 1652) will translateoutwardly simultaneously, at the same rate, for the same distance. Whilethis occurs, the angled surfaces of arms (1642, 1652) will guide anvil(60, 1660) downwardly along a path that is centered along a verticalplane passing longitudinally through the central longitudinal axis ofbuttress assembly (100) and platform (1620). In other words, retentionfeatures (1640, 1650) and pinion (1670) will cooperate to not onlyaccommodate anvils (60, 1660) having different widths; but also toensure that anvil (60, 1660) remains properly centered along thevertical plane passing through the lateral center of buttress assembly(100) and platform (1620). Retention features (1640, 1650) and pinion(1670) thus ensure that buttress assembly (100) has proper lateralalignment on anvil (60, 1660) regardless of whether a narrow anvil (60)or wide anvil (1660) is used.

IX. EXEMPLARY MULTI-STAGE BUTTRESS APPLIER CARTRIDGE

In some instances, it may be desirable to provide an operator with abuttress applier cartridge that provides the operator with more optionsthan just simply applying buttress assemblies (100, 110) in a singlestroke of end effector (40). For instance, FIG. 37 shows a buttressapplier cartridge (2000) that provides a plurality of stations (2010,2020, 2030, 2040, 2050) for an operator to choose from. Each station(2010, 2020, 2030, 2040, 2050) is sized and configured to receive endeffector (40). Each station (2010, 2020, 2030, 2040, 2050) includes arespective panel (2012, 2022, 2032, 2042, 2052) that the operator mayclamp on with end effector (40). In the present example, panel (2012)includes a low strength adhesive disposed thereon. Panel (2022) includesa high strength adhesive disposed thereon. Panel (2032) includes abuttress body (e.g., like buttress body (102) disposed thereon. In someversions, panel (2032) includes a plurality of buttress bodies (e.g.,similar to the arrangement described above with reference to FIGS.28-29). It should therefore be understood that cartridge (2000) may beused repeatedly to apply a series of buttress assemblies (100, 110) to asingle end effector (40) during a single surgical procedure. Panel(2042) includes a hydrophilic drying material disposed thereon. Panel(2052) includes an abrasive material disposed thereon. Of course, theseare just merely illustrative examples, and it should be understood thatpanels (2012, 2022, 2032, 2042, 2052) may have any other suitablefeatures and/or materials disposed thereon. In the present example, eachstation (2010, 2020, 2030, 2040, 2050) includes an identifier (2014,2024, 2034, 2044, 2054) associated with each panel (2012, 2022, 2032,2042, 2052). Each identifier (2014, 2024, 2034, 2044, 2054) indicatesthe features or materials that re disposed on the corresponding panel(2012, 2022, 2032, 2042, 2052).

In an exemplary use of cartridge (2000), an operator may first clamp endeffector (40) on panel (2012) to pick up adhesive; then clamp on panel(2032) to pick up bodies (102, 112), thereby forming buttress assemblies(100, 110) on end effector (40). The operator may then insert endeffector (40) into a patient and then actuate end effector (40) to applystaples (90) and buttress bodies (102, 112) to tissue. The operator maythen remove end effector (40) from the patient, remove the spentcartridge (70) from lower jaw (50), and swish end effector (40) insaline to at least partially clean end effector (40). The operator maythen use panel (2052) to scrub end effector (2052) to remove any excessadhesive material from underside (65) of anvil (60), swish end effector(40) again in saline, then dry end effector (40) on panel (2042). Theoperator may then load a new staple cartridge (70) in lower jaw (50) andrepeat the above process by clamping again on panel (2012) to pick upadhesive, etc. Of course, cartridge (2000) may be used in any othersuitable fashion. It should be understood that an operator may clamp endeffector (40) on any number of panels (2012, 2022, 2032, 2042, 2052) andin any suitable sequence.

It should also be understood that some variations of cartridge (2000)may include a panel having a lubricant. The lubricant may be applied toend effector (40) after buttress assemblies (100, 110) are applied doend effector (40). The lubricant may facilitate placement of buttressassemblies (100, 110) on tissue without buttress assemblies (100, 110)becoming misaligned on end effector (40) due to sliding contact withtissue. Other suitable variations will be apparent to those of ordinaryskill in the art in view of the teachings herein.

X. EXEMPLARY ALTERNATIVE BUTTRESS ASSEMBLY CONFIGURATIONS

As noted above, the configurations of buttress assemblies (100, 110)shown in FIG. 4 are merely illustrative examples. Moreover, as shown inFIG. 19 and other drawings of the present application, each buttressassembly (100, 110) may be provided in two laterally spaced apartportions, with the two portions of each buttress assembly (100, 110)being separated by a gap that complements the width of channels (62, 72)in anvil (60) and staple cartridge (70). In versions where a buttressassembly (100, 110) is provided in two portions that are laterallyseparated by a gap, it may be desirable to provide one or more featuresthat generally maintain the lateral spacing of those portions. Suchfeatures may also ensure (or at least promote) that the portions remaingenerally parallel with each other in addition to ensuring (or at leastpromoting) that the portions are separated by a consistent gap. FIGS.38-41 show merely illustrative examples of structures that may be usedto provide such functionality in buttress assemblies (100, 110). Itshould be understood that the modifications described below may bereadily incorporated into any of the versions of buttress assemblies(100, 110) described above; and that the modified buttress assembliesdescribed below may be readily used with any of the various buttressapplier cartridges described above.

FIG. 38 shows a buttress applier cartridge (2500) containing yet anotherexemplary alternative buttress assembly (2550). Cartridge (2500) of thisexample comprises a housing (2510), retention features (2512), and aplatform (2520) similar to other housings, retention features, andplatforms described herein. Buttress assembly (2500) of this example issubstantially identical to buttress assembly (100, 110) except thatbuttress assembly (2500) is in the form of a roll that is containedwithin housing (2510). The roll comprises a plurality of segments (2552)that are separated by weak portions (2554). Each segment (2552) has alength complementing the length of underside (65) and/or the length ofdeck (73). Weak portions (2554) are configured to enable an operator toeasily tear one segment (2552) from the next segment (2552). Thus, theoperator may use the same cartridge (2500) to apply several differentsegments (2552) to an end effector (40) during a single surgicalprocedure. It should be understood that buttress assembly (2550) mayalso be incorporated into cartridge (2000) described above withreference to FIG. 37 (e.g., with buttress assembly (2550) being appliedvia panel (2032)). Other suitable variations will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

FIGS. 38-41 show an exemplary alternative buttress assembly (2600) thatcomprises a buttress body (2602) and an attachment feature (2604).Buttress body (2602) may be constructed and operable just like any otherbuttress body described herein and/or like any buttress body describedin any references cited herein. Attachment feature (2604) comprises ahollow tubular structure that is secured to one side of buttress body(2602). In particular, attachment feature (2604) extends along the fulllength of buttress body (2602) and is laterally centered on buttressbody (2602). While attachment feature (2604) extends continuously alongthe full length of buttress body (2602) in this example, it should beunderstood that attachment feature (2604) may instead be broken intosegments that are longitudinally spaced apart from each other. In thepresent example, attachment feature (2604) comprises an extrudedabsorbable polymer (e.g., PGA, etc.) that is thermally bonded tobuttress body (2602). Alternatively, any other suitable material(s) maybe used to form attachment feature (2604); and any other suitabletechniques may be used to secure attachment feature (2604) to buttressbody (2602).

Attachment feature (2604) is resiliently biased to have a circularcross-sectional configuration as best seen in FIG. 40A. However,attachment feature (2604) is configured and dimension such thatattachment feature (2604) may be compressed inwardly to deformably fitwithin channel (62) of anvil (60) as shown in FIG. 40B. When attachmentfeature (2604) is located within channel (62), the hoop stresses imposedby the resilient bias of attachment feature (2604) will provide frictionagainst the inner sidewalls of anvil (60) that define channel (62),thereby securing attachment feature (2604) within channel (62). Thesecure positioning of attachment feature (2604) within channel (62) willfurther secure buttress body (2602) against underside (65) of anvil(60). It should therefore be understood that attachment feature (2604)may be used in lieu of providing an adhesive layer on buttress body(2602) to secure buttress body (2602) against underside (65) of anvil(60). Alternatively, attachment feature (2604) may be used to supplementan adhesive layer on buttress body (2602) to secure buttress body (2602)against underside (65) of anvil (60). It should also be understood thatattachment feature (2604) may be fitted within channel (62) by anvil(60) closing down on buttress assembly (2600), such that buttressassembly (2600) may be readily used with the various buttress appliercartridges described herein.

When an end effector (40) that is loaded with buttress assembly (2600)is actuated, knife member (80) may bisect attachment feature (2604)along a longitudinal cut path while knife member (80) simultaneouslybisects buttress body (2602) along the same path. This may result in aconfiguration as shown in FIG. 41. In particular, FIG. 41 shows buttressbody (2602) bisected into two pieces (2602 a, 2602 b) that are securedto corresponding regions of tissue (T) via staples (90); with attachmentfeature (2604) also having been bisected into two corresponding pieces(2604 a, 2604 b). While buttress assembly (2600) is shown and describedin the foregoing example as being used with anvil (60), it should beunderstood that buttress assembly (2600) may also be readily used withstaple cartridge (70). In particular, attachment feature (2604) may bepositioned on the underside of a buttress body (2602); and may fitwithin channel (72) of staple cartridge (70).

XI. EXEMPLARY ALTERNATIVE FEATURES FOR SECURING BUTTRESS ASSEMBLY TOANVIL

As indicated above with respect to attachment feature (2604), it may bedesirable to use something other than an adhesive (or in addition to anadhesive) in order to removably secure a buttress body to an endeffector (40). To that end, FIGS. 42-43B show an exemplary alternativecombination of a buttress body (2652), anvil (2660), and retention clip(2670). Buttress body (2652) may be constructed and operable just likeany other buttress body described herein and/or like any buttress bodydescribed in any references cited herein. Anvil (2660) of this exampleis substantially identical to anvil (2660) described above; except thatanvil (2660) of this example includes a transverse slot (2664) that isin communication with longitudinally extending channel (2662). Moreover,the distal end of anvil (2660) includes inwardly directed projections(2688) adjacent to channel (2662) and slot (2664).

Clip (2670) of the present example generally defines a “U” shape andincludes a set of buttress engagement prongs (2672), a set of humps(2674), and a set of flange prongs (2676). As best seen in FIGS.43A-43B, clip (2670) is configured to wrap around projections (2688),with flange prongs (2676) being positioned in slot (2664) and withbuttress engagement prongs (2678) extending underneath projections(2688). Clip (2670) is resiliently biased to assume the configurationshown in FIG. 43A. In this configuration, prongs (2678) pinch the distalend of buttress body (2652) against underside (2665) of anvil (2660).Since clip (2670) is secured to anvil (2660), the pinching of buttressbody (2652) between prongs (2678) and humps (2674) will assist insecuring buttress body (2652) against underside (2665) of anvil (2660).In some versions, clip (2670) serves as a substitute for an adhesive tosecure buttress body (2652) against underside (2665) of anvil (2660). Insome other versions, clip (2670) serves as a supplement for an adhesiveto secure buttress body (2652) against underside (2665) of anvil (2660).

Clip (2670) of the present example is configured to interact with amodified version of knife member (80) to selectively release buttressbody (2652) from underside (2665) of anvil (2660) when end effector (40)is actuated. In particular, FIG. 43B shows a modified knife member(2680) interacting with clip member (2670). Knife member (2680) issubstantially identical to knife member (80) and includes a cutting edge(2684); but knife member (2680) further includes a pair of upper flanges(2686) in this example. Flanges (2686) extend transversely outwardlyfrom the upper region of knife member (2680) and are slidably disposedin slot (2664) of anvil (2660). As knife member (2680) is translated tothe distal position shown in FIG. 43B, flanges (2686) engage prongs(2676) and thereby drive a first portion of clip (2670) upwardly.Projections (2668) bear downwardly on a second portion of clip (2670) asflanges (2686) drive the first portion of clip (2670) upwardly. Thisprovides separation between prongs (2678) and humps (2674), such thatclip (2670) releases buttress body (2652) as shown in FIG. 43B. Itshould therefore be understood that knife member (2680) will deform clip(2670) and thereby cause clip (2670) to release buttress body (2652)when knife member (2680) reaches a distal position during actuation ofend effector (40).

While retention clip (2670) is shown and described in the foregoingexample as being used with a modified anvil (2660), it should beunderstood that retention clip (2670) (or a modification thereof) mayalso be readily used with a modification of staple cartridge (70). Inparticular, retention clip (2670) may be located at the distal end ofstaple cartridge (70) and may deform in response to engagement by alower flange of knife member (2680), thereby releasing a lower buttressbody from the deck (73) of the modified staple cartridge (70).

XII. SURGICAL STAPLER BUTTRESS APPLICATOR WITH MULTI-ZONE PLATFORM FORPRESSURE FOCUSED RELEASE

In the example above, platform (220) is provided as a generally flat,stationary members that simply provide support to buttress assemblies(100, 110) until buttress assemblies (100, 110) are adhered to endeffector (40). It may be desirable to provide additional functionalityto platform (220). For instance, it may be desirable to incorporatefeatures into platform (220) that further promote adhesion of buttressassemblies (100, 110) to end effector (40). This may be done byproviding variation of pressure among certain areas of end effector (40)when end effector (40) clamps down on buttress assemblies (100, 110) andplatform (220). In particular, pressure may be localized or otherwiseapplied differently based on the location on platform (220) by providingsurface features that concentrate compressive forces in certain regionsof the entire clamping footprint of end effector (40). The concentrationof compressive forces in these regions may provide greater adhesion inthose regions than might otherwise be achieved through versions whereplatform (220) is simply flat. The following examples include severalways in which platform (220) may provide different amounts of pressurebased on the location on the platform. It should be understood that anyof the platforms described below may be readily incorporated intocartridge (200) as described above.

A. Exemplary Buttress Applier Cartridge with Platform Having LocalizedPressure Applying Surface Features

FIG. 44 shows an exemplary alternative buttress applier cartridge (600)that may be used to support and protect buttress assemblies (100, 110).Cartridge (600) may also be used to easily load buttress assemblies(100, 110) on end effector (40). Cartridge (600) of this exampleincludes a housing (610), a platform (620), and a plurality of retentionmembers (652) that are configured to releasably secure buttressassemblies (100, 110) to platform (520) just like arms (252) or arms(352) described above. It should be understood that retention members(652) are provided by way of example only; and that cartridge (600) mayinstead include any other suitable kinds of buttress assembly (100, 110)retention features, including but not limited to those describedelsewhere herein.

Platform (620) of the present example includes a plurality ofprotrusions (622) and a plurality of fins (624). In some versions,protrusions (622) and/or fins (624) are rigid. Protrusions (622) are inthe form of an array of short, flat-topped pegs in the present example,though it should be understood that protrusions (622) may take a varietyof alternative forms. Fins (624) are sized and arranged to fit inchannel (62) of anvil (60). It should be understood that fins (624) maycooperate with the sidewalls defining channel (62) to ensure that anvil(60) is properly aligned with buttress assembly (100) as anvil (60) isclosed down toward buttress assembly (100) and platform (620). It shouldalso be understood that the underside of platform (620) (i.e., the sidecarrying buttress assembly (110), associated with staple cartridge(70)), may also include protrusions (622) and fins (624). Fins (624) onthe underside of platform (620) may be sized and arranged to fit inchannel (72) of staple cartridge (70). Moreover, as will be described ingreater detail below, fins (624) on the underside of platform (620) maybe configured to prevent cartridge (600) from being used with a staplecartridge (70) that has already been fired.

As shown in FIG. 45A, protrusions (622) directly engage body (102) ofbuttress assembly (100), and thereby support buttress assembly (100) ata plurality of discrete locations along body (102). FIG. 45B shows anvil(60) clamping down on buttress assembly (100) and platform (620). Asshown, protrusions (622) provide localized pressure on adhesive layer(104) against the underside (65) of anvil (60). This localizationprovides greater pressure at the regions associated with protrusions(622) than would otherwise be applied on adhesive layer (104) againstthe underside (65) of anvil (60) if platform (620) lacked protrusions(622). When anvil (60) is pulled away from platform (620) (e.g., whenend effector (40) is returned to the open position), buttress assembly(100) is adhered to underside (65), with adhesion maximized at thelocations associated with protrusions (622) as shown in FIG. 45C.

FIGS. 46A-46C show another exemplary alternative platform (670) that maybe readily incorporated into cartridge (600) in place of platform (620).Platform (670) of this example is substantially identical to platform(620) described above, except that platform (670) of this example has asurface geometry in the form of a triangular wave. In some versions, thetriangular wave configuration extends along only one cross-sectionaldimension, such that the peaks (672) of the triangular wave span acrossthe entire width of platform (670) like ridges. In some other versions,the triangular wave configuration extends along two cross-sectionaldimensions, such that the peaks (672) of the triangular wave formdiscrete points.

As shown in FIG. 46A, peaks (672) directly engage body (102) of buttressassembly (100), and thereby support buttress assembly (100) at aplurality of discrete locations along body (102). FIG. 46B shows anvil(60) clamping down on buttress assembly (100) and platform (670). Asshown, peaks (672) provide localized pressure on adhesive layer (104)against the underside (65) of anvil (60). This localization providesgreater pressure at the regions associated with peaks (672) than wouldotherwise be applied on adhesive layer (104) against the underside (65)of anvil (60) if platform (670) lacked peaks (672). When anvil (60) ispulled away from platform (670) (e.g., when end effector (40) isreturned to the open position), buttress assembly (100) is adhered tounderside (65), with adhesion maximized at the locations associated withpeaks (672) as shown in FIG. 46C.

It should be understood that the cylindraceous peg configuration ofprotrusions (622) and the triangular wave peak configuration of peaks(672) are merely illustrative examples. Other features and surfacegeometries that may be incorporated into a platform to provide localizedpressure will be apparent to those of ordinary skill in the art in viewof the teachings herein.

B. Exemplary Buttress Applier Cartridge with Platform Having Regions ofVarying Compression Characteristics

FIG. 47 shows another exemplary alternative buttress applier cartridge(700) that may be used to support and protect buttress assemblies (100,110). Cartridge (700) may also be used to easily load buttressassemblies (100, 110) on end effector (40). Cartridge (700) of thisexample comprises an open end (702) and a closed end (704). Open end(702) is configured to receive end effector (40) as described above.Cartridge (700) further includes a first housing (710) and a secondhousing (718), which each generally define a “U” shape to present openend (402). A platform (720) is interposed between housings (710, 718).

In some versions, buttress assemblies (100, 110) are adhered to platform(720). By way of example only, buttress assemblies (100, 110) may beadhered to platform (720) using the same adhesive material that is usedto adhere buttress assemblies (100, 110) to underside (65) of anvil (60)and deck (73) of staple cartridge (70). In some such versions, the sidesof buttress assemblies (100, 110) that are adhered to platform (720)include less adhesive material than the amount of adhesive material thatis used to adhere buttress assemblies (100, 110) to underside (65) ofanvil (60) and deck (73) of staple cartridge (70), to thereby promoterelease of buttress assemblies (100, 110) from platform (720) whenbuttress assemblies (100, 110) are adhered to underside (65) of anvil(60) and deck (73) of staple cartridge (70). For instance, the adhesivemay be provided in only discrete portions (e.g., in a pattern) along thesides of buttress assemblies (100, 110) that are adhered to platform(720).

Platform (720) of the present example comprises a body (722) and anarray of resilient assemblies (724). Body (722) of the present exampleis compressible; and resilient assemblies (724) are also compressible.However, body (722) is configured to maintain a generally compressedconfiguration after being compressed then released; while resilientassemblies (724) are configured to generally return to a non-compressedconfiguration after being compressed then released. In addition, duringcompression of platform (720), the resilience of resilient assemblies(724) will provide a greater outward resistance on whatever iscompressing platform (720) than the outward resistance provided by body(722) of platform (720). By way of example only, each resilient assembly(724) may comprise a coil spring in a sheath; and resilient assemblies(724) may be snugly fit in respective undersized openings of body (722).Other suitable forms that resilient assemblies (724) may take will beapparent to those of ordinary skill in the art in view of the teachingsherein. It should also be understood that a variety of materials andconfigurations may be used to form body (722), including but not limitedto a viscous foam material.

FIGS. 48A-48C show a sequence where buttress assemblies (100, 110) andplatform (720) are compressed and released by end effector (40). In thisexample, buttress assembly (100) is modified to include severalintegral, discrete protrusions (106) projecting downwardly from body(102). Similarly, buttress assembly (110) is modified to include severalintegral, discrete protrusions (116) projecting upwardly from body(102). Protrusions (106, 116) may be rigid or semi-rigid. By way ofexample only, protrusions (106, 116) may be shaped like short,cylindraceous pegs. Alternatively, protrusions (106, 116) may have anyother suitable configuration.

At the stage shown in FIG. 48A, before end effector (40) is clamped downon buttress assemblies (100, 110) and platform (720), the upper andlower surfaces of body (722) are flush with the upper and lower ends ofresilient assemblies (724), such that the upper and lower surfaces ofplatform (720) are substantially flat. Buttress assemblies (100, 110)are supported on platform (720) via protrusions (106, 116). In thepresent example, protrusions (106, 116) and resilient assemblies (724)are positioned and arranged such that protrusions (106, 116) do notengage the ends of any of resilient assemblies (724). In other words,protrusions (106, 116) only engage body (722) of platform (720).

FIG. 48B shows end effector (40) clamping down on where buttressassemblies (100, 110) and platform (720). As shown, protrusions (106,116) engage body (722) to maximize compression of body (722) relative toresilient assemblies (724). Resilient assemblies (724) bear directly onbodies (102, 112) of buttress assemblies (100, 110), providing localizedpressure similar to that provided protrusions (622) as described above.Thus, resilient assemblies (724) simultaneously enhance adhesion ofadhesive layer (104) to underside (65) and adhesion of adhesive layer(114) to deck (73).

FIG. 48C shows end effector (40) returning to an open position, carryingbuttress assemblies (100, 110) away from platform (720). Platform (720)is thus no longer being compressed by end effector (40). Nevertheless,body (722) maintains a substantially compressed configuration; whileresilient assemblies (724) return to a generally uncompressedconfiguration. Buttress assemblies (100, 110) remain adhered to endeffector (40), with enhanced adhesion provided by resilient assemblies(724), such that end effector (40) with buttress assemblies (100, 110)may be used to perform a surgical procedure as described above. Itshould be understood that body (722) does not necessarily need tomaintain a substantially compressed configuration at the stage shown inFIG. 48C. In other words, body (722) may provide some degree ofresilience. However, in versions where body (722) is resilient, theresilience of resilient assemblies (724) may be stronger than theresilience of body (722), such that resilient assemblies (724) mayeffectively provide localized concentrations of pressure againstbuttress assemblies (100, 110) when end effector (40) is closed uponbuttress assemblies (100, 110) and platform (720).

FIGS. 49A-49C show another exemplary alternative platform (770) that maybe readily incorporated into cartridge (700) or any other buttressapplier cartridge described herein. As with platform (720) describedabove, buttress assemblies (100, 110) may be adhered to platform (770)in some versions. Platform (770) of this example comprises a body (772)with a plurality of resilient members (774) disposed in body (772). Body(772) of the present example is compressible; and resilient members(774) are also compressible. However, body (772) is configured tomaintain a generally compressed configuration after being compressedthen released (or at least take longer to return to the non-compressedconfiguration); while resilient members (774) are configured togenerally return to a non-compressed configuration after beingcompressed then released (or return to the non-compressed configurationfaster than body (772)). In other words, body (772) has a greaterviscosity than resilient members (774). In addition, during compressionof platform (770), the resilience of resilient members (774) willprovide a greater outward resistance on whatever is compressing platform(770) than the outward resistance provided by body (772) of platform(770). By way of example only, each resilient member (774) may comprisea cylinder of material that has a greater density than the materialforming body (772). In some versions, resilient members (774) and body(772) are formed of the same foam material; yet the foam materialforming resilient members (774) has a greater density than the foammaterial forming body (772). Other suitable forms that resilient members(724) may take will be apparent to those of ordinary skill in the art inview of the teachings herein.

At the stage shown in FIG. 49A, before end effector (40) is clamped downon buttress assemblies (100, 110) and platform (770), the upper andlower surfaces of body (772) are flush with the upper and lower ends ofresilient assemblies (774), such that the upper and lower surfaces ofplatform (770) are substantially flat. Buttress assemblies (100, 110)are supported flatly on platform (770). In some variations, buttressassemblies (100, 11) include protrusions (106, 116) when used withplatform (770).

FIG. 49B shows end effector (40) clamping down on where buttressassemblies (100, 110) and platform (770). As shown, resilient members(774) bear directly on bodies (102, 112) of buttress assemblies (100,110), providing localized pressure similar to that provided protrusions(622) as described above. Thus, resilient members (774) simultaneouslyenhance adhesion of adhesive layer (104) to underside (65) and adhesionof adhesive layer (114) to deck (73).

FIG. 49C shows end effector (40) returning to an open position, carryingbuttress assemblies (100, 110) away from platform (770). Platform (770)is thus no longer being compressed by end effector (40). Nevertheless,body (772) maintains a substantially compressed configuration; whileresilient members (774) return to a generally uncompressedconfiguration. Buttress assemblies (100, 110) remain adhered to endeffector (40), with enhanced adhesion provided by resilient members(774), such that end effector (40) with buttress assemblies (100, 110)may be used to perform a surgical procedure as described above. Itshould be understood that body (772) does not necessarily need tomaintain a substantially compressed configuration at the stage shown inFIG. 49C. However, in versions where body (772) is resilient, theresilience of resilient members (774) may be stronger than theresilience of body (772), such that resilient members (774) mayeffectively provide localized concentrations of pressure againstbuttress assemblies (100, 110) when end effector (40) is closed uponbuttress assemblies (100, 110) and platform (770).

FIG. 50 shows yet another exemplary alternative platform (800) that maybe readily incorporated into cartridge (700) or any other buttressapplier cartridge described herein. Platform (800) of this examplecomprises a first longitudinally extending body zone (802) and a pair ofsecond longitudinally extending body zones (804). Body zones (804)extend longitudinally along both lateral sides of body zone (802) andare laterally separated by a distance (d). Body zones (804) are sizedand positioned to correspond with the lateral outermost regions ofunderside (65) of anvil (60) and deck (73) of staple cartridge (70). Insome versions, all body zones (802, 804) are compressible but body zone(802) has a durometer that is different from the durometer of body zones(804). For instance, in some versions body zone (802) is configured tomaintain a generally compressed configuration after being compressedthen released while body zones (804) are configured to generally returnto a non-compressed configuration after being compressed then released.In addition, during compression of platform (800), the resilience ofbody zones (804) will provide a greater outward resistance on whateveris compressing platform (800) than the outward resistance provided bybody zone (802) of platform (800). By way of example only, each bodyzone (804) may comprise a material that has a greater density than thematerial forming zone (802). In some versions, body zones (804) and bodyzone (802) are formed of the same foam material; yet the foam materialforming body zones (804) has a greater density than the foam materialforming body zone (802). Other suitable forms that body zones (804) maytake will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

Before end effector (40) is clamped down on buttress assemblies (100,110) and platform (800), the upper and lower surfaces of body zone (802)are flush with the upper and lower ends of body zones (804), such thatthe upper and lower surfaces of platform (800) are substantially flat.Buttress assemblies (100, 110) are supported flatly on platform (800).When end effector (40) clamps down on where buttress assemblies (100,110) and platform (800) as described above, body zones (804) beardirectly on bodies (102, 112) of buttress assemblies (100, 110),providing localized pressure along the lateral outermost regions ofunderside (65) of anvil (60) and deck (73) of staple cartridge (70).Thus, body zones (804) simultaneously enhance adhesion of adhesive layer(104) to underside (65) and adhesion of adhesive layer (114) to deck(73).

After end effector (40) returns to an open position, carrying buttressassemblies (100, 110) away from platform (800), body zone (802) maymaintain a substantially compressed configuration; while body zones(804) return to a generally uncompressed configuration. Buttressassemblies (100, 110) remain adhered to end effector (40), with enhancedadhesion provided by body zones (804), such that end effector (40) withbuttress assemblies (100, 110) may be used to perform a surgicalprocedure as described above. It should be understood that body zone(802) does not necessarily need to maintain a substantially compressedconfiguration after end effector (40) returns to an open position.However, in versions where body zone (802) is resilient, the resilienceof body zones (804) may be stronger than the resilience of body zone(802), such that body zones (804) may effectively provide localizedconcentrations of pressure against buttress assemblies (100, 110) whenend effector (40) is closed upon buttress assemblies (100, 110) andplatform (800).

C. Exemplary Buttress Applier Cartridge with Platform Having VaryingThickness

In addition to or as an alternative to modifying a platform to includesurface features or resilient features that provide enhanced pressure inlocalized regions, it may be desirable to provide a buttress appliercartridge with a platform that has varying thickness to enhance orotherwise promote adhesion between buttress assemblies (100, 110) andend effector (40). For instance, FIG. 51 shows an exemplary platform(810) that may be readily incorporated into cartridge (700) or any otherbuttress applier cartridge described herein. Platform (810) of thisexample comprises a longitudinally extending thin region (812) that isflanked by longitudinally extending thick regions (814). In the presentexample, platform (810) is a single, homogenous continuum of materialthat is formed to include regions (812, 814). In some other versions,regions (814) are initially formed separately from region (812) and arethen joined to regions (812) to form an integral unit.

As shown in FIG. 51, thick regions (814) are configured to complementrecessed regions (69) on underside (65) of anvil (60). Regions (812,814) thus cooperate to ensure that buttress assembly (100) is appliedwith uniform pressure along the full width of underside (65), includingrecessed regions (69). It should be understood that, if platform (810)instead had a uniform thickness across the width of platform (810)(e.g., lacking thick regions (814)), buttress assembly (100) may not beadhered as well to recessed regions (69) on underside (65) of anvil(60).

While the thickness of platform (810) varies along the width of platform(810), it may also be desirable to vary the thickness of a platformalong the length of the platform. FIG. 52 shows yet another exemplaryplatform (820) that may be readily incorporated into cartridge (700) orany other buttress applier cartridge described herein. Platform (820) ofthis example is tapered along the length of platform (820). Inparticular, the proximal end (822) of platform (820) is thinner than thedistal end (824) of platform (820). When a buttress applier cartridgeincorporating platform (820) is positioned in an open end effector (40),proximal end (822) would be positioned closer to the pivot regionbetween anvil (60) and lower jaw (50), and distal end (824) would bepositioned closer to the distal ends of anvil (60) and staple cartridge(70).

The tapered profile of platform (820) may complement the closure profileof anvil (60) as anvil (60) is clamped down onto a buttress assembly(100) on platform (820). In particular, as anvil (60) is closed towardlower jaw (50) and staple cartridge (70), anvil (60) may define an acuteangle with lower jaw (50) and staple cartridge (70) up until anvil (60)reaches a fully closed position. Once anvil (60) reaches a fully closedposition, anvil (60) may be parallel with lower jaw (50) and staplecartridge (70). If an operator fails to fully close anvil (60) when theoperator is attempting to adhere a buttress assembly (100) to underside(65), the increased thickness at the distal end (824) of platform (820)may increase the likelihood of successful adhesion in the distal regionsof underside (65) and buttress assembly (100) even though anvil (60)never achieves a fully parallel orientation with respect to lower jaw(50) and staple cartridge (70).

FIG. 53 shows yet another exemplary platform (830) that may be readilyincorporated into cartridge (700) or any other buttress appliercartridge described herein. Platform (830) of this example has arelatively thin proximal end (832) and distal end (834), with arelatively thick central region (838). Platform (830) has a flat lowersurface (837) and a convex upper surface (836). Flat lower surface (837)is configured to complement the generally flat surface of deck (73) ofstaple cartridge (70). Convex upper surface (836) is configured tocomplement a curved anvil (67). Anvil (67) of this example issubstantially identical to anvil (60) described above and may be readilyincorporated into end effector (40). However, anvil (67) of this examplehas a slightly curved underside (68). In some versions, the radius ofcurvature of convex upper surface (836) complements the radius ofcurvature of underside (68), thereby ensuring that a buttress assembly(100) that is disposed on convex upper surface (836) will be adhered tounderside (68) with uniform pressure along the full length of underside(68). It should be understood, however, that convex upper surface (836)may have a radius of curvature that is less than the radius of curvatureof underside (68). Similarly, platform (830) may be used with an anvil(60) that has a substantially flat underside (68). In such versions, thecurvature of convex upper surface (836) may force contact betweenbuttress assembly (100) at the longitudinal center of underside (65) ofanvil (60) first; and apply the most pressure to the longitudinal centerof underside (65) of anvil (60) to ensure maximum fixation of buttressassembly (100) at the longitudinal center of underside (65) of anvil(60). This may minimize the risk of buttress assembly (100) slippingalong underside (65) of anvil (60) during manipulation of tissue orplacement of anvil (60) on tissue.

Other suitable ways in which the thickness of a platform may be variedalong the width and/or length of the platform will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

D. Exemplary Alternative Buttress Retention Features for ButtressApplier Cartridges

As described above, a cartridge (200) may secure buttress assemblies(100, 110) to platform (220) using arms (252). However, it will beunderstood that arms (252) are merely illustrative examples ofstructures that may be used to secure buttress assemblies (100, 110) toplatform (220). Several additional structures that may be used to securebuttress assemblies (100, 110) to platform (220) will be described ingreater detail below, while still further examples will be apparent tothose of ordinary skill in the art in view of the teachings herein. Itshould be understood that the following teachings may be readilyincorporated into any of the various buttress applier cartridgesdescribed herein.

1. Exemplary Buttress Retention Features Integrated into Platform ofButtress Applier Cartridge

In cartridge (200) described above, buttress assemblies (100, 110) aresecured to platform (220) using features positioned along the outwardlateral edges of buttress assemblies (100, 110). In particular, arms(252) secure buttress assemblies (100, 110) in cartridge (200). Inaddition to or as an alternative to using these kinds of features tosecure buttress assemblies (100, 110) to a platform, it may be desirableto incorporate features directly into a platform that secure buttressassemblies (100, 110) to the platform. The following provides merelyillustrative examples of how a platform may include integral featuresthat releasably secure buttress assemblies (100, 110) to the platform.Other suitable variations will be apparent to those of ordinary skill inthe art in view of the teachings herein.

a. Exemplary Platform with Integral, Collapsible Retainer Posts

FIG. 54 shows an exemplary alternative buttress applier cartridge (840)that may be used to support and protect buttress assemblies (100, 110).Cartridge (840) may also be used to easily load buttress assemblies(100, 110) on end effector (40). Cartridge (840) of this exampleincludes a housing (842) and a platform (844). Platform (844) of thisexample is substantially identical to platforms (220) described above,except that platform (844) of this example includes fastener assemblies(845). Fastener assemblies (845) extend through the thickness ofplatform (844) and buttress assemblies (100, 110); and are arranged inan array such that fastener assemblies (845) are generally equidistantlyspaced from each other along the surfaces of buttress assemblies (100,110). As described in further detail below, fastener assemblies (845)releasably secure buttress assemblies (100, 110) to platform (845). Inthe present example, cartridge (840) lacks arms (252). In some otherversions, fastener assemblies (845) are provided as a supplement to arms(252). It should therefore be understood that fastener assemblies (845)may be used in combination with other features such as arms (252).

As best seen in FIGS. 55A-55C, each fastener assembly (845) comprises amale member (850) and a female member (860). Male member (850) comprisesa head (852) and a shank (854) extending downwardly from head (852).Head (852) is positioned on top of buttress assembly (100). Head (852)is sized and configured to releasably hold buttress assembly (100) onplatform (844). Shank (854) extends through buttress assembly (100) andplatform (844). Shank (854) includes a longitudinally spaced array ofannular ridges or barbs. Female member (860) comprises a head (862) anda shank (864) extending upwardly from head (862). Head (862) ispositioned below buttress assembly (110). Head (862) is sized andconfigured to releasably hold buttress assembly (110) on platform (844).Shank (864) extends through buttress assembly (110) and platform (844).Shank (864) includes a recess that includes a longitudinally spacedarray of interior annular ridges or barbs. These interior features ofshank (864) are configured to complement the exterior features of shank(854).

FIG. 55A shows platform (844), fastener assemblies (845), and buttressassemblies (100, 110) prior to engagement with end effector (40). Asshown, shanks (854, 864) are separated from each other. Shanks (854,864) nevertheless provide enough friction with the material of platform(844) to cooperate with heads (852, 862) in such a way that fastenerassemblies (845) secure buttress assemblies (100, 110) to platform(844).

FIG. 55B shows platform (844), fastener assemblies (845), and buttressassemblies (100, 110) being clamped by a closed end effector (40). Asshown, closure of end effector (40) compresses platform (844), therebydriving members (850, 860) into engagement with each other. Inparticular, shank (854) enters shank (864), reducing the effectiveheight of fastener assembly (845). The exterior ridges or barbs of shank(854) ratchetingly engage the complementary interior features of shank(864), thereby fixedly securing members (850, 860) together. At thisstage, adhesive layers (102, 112) (not shown in FIG. 55B) securebuttress assemblies (100, 110) to anvil (60) and staple cartridge (70),respectively.

FIG. 55C shows platform (844), fastener assemblies (845), and buttressassemblies (100, 110) after being released by the clamped end effector(40). As shown, members (850, 860) remain engaged with each other due tothe engagement between the exterior ridges or barbs of shank (854) andthe complementary interior features of shank (864). Platform (844) hasself-expanded back to a non-compressed state. Buttress assemblies (100,110) remain secured to anvil (60) and staple cartridge (70),respectively. During the transition from the stage shown in FIG. 55B tothe stage shown in FIG. 55C, heads (852, 862) have torn through buttressassemblies (100, 110). Buttress assemblies (100, 110) are thus releasedfrom platform (844) while fastening assemblies (845) remain engaged withplatform (844). End effector (40) is then ready for use in a surgicalprocedure as described above.

b. Exemplary Platform with Integral, Frangible Retainer Stems

FIGS. 56A-56C show another exemplary platform (870) and fasteningassembly (880) that may be used in lieu of platform (844) and fasteningassembly (845) described above. It should be understood that platform(870) may include an array of fastening assemblies (880), just likeplatform (844) including an array of fastening assemblies (845) asdescribed above. It should also be understood that platform (870) andfastening assembly (880) may be used in any of the cartridges describedherein, with or without additional fastening features such as arms(252), etc.

Fastening assembly (880) of the present example comprises a first head(882), a second head (884), and a frangible stem (886) extending betweenheads (882, 884). Head (882) is positioned above buttress assembly (100)and is configured to hold buttress assembly (100) on platform (870).Head (884) is positioned below buttress assembly (110) and is configuredto hold buttress assembly (110) on platform (870). Stem (886) passesthrough buttress assemblies (100, 110) and platform (870) to secureheads (882, 884) together. It should therefore be understood that heads(882, 884) and stem (886) cooperate to secure buttress assemblies (100,110) to platform (870).

FIG. 56A shows platform (870), fastener assembly (880), and buttressassemblies (100, 110) prior to engagement with end effector (40). FIG.56B shows platform (870), fastener assembly (880), and buttressassemblies (100, 110) being clamped by a closed end effector (40). Asshown, closure of end effector (40) compresses platform (870), therebyheads (882, 884) toward each other. This causes stem (864) to fracture.At this stage, adhesive layers (102, 112) (not shown in FIG. 56B) securebuttress assemblies (100, 110) to anvil (60) and staple cartridge (70),respectively.

FIG. 56C shows platform (870), fastener assembly (880), and buttressassemblies (100, 110) after being released by the clamped end effector(40). As shown, platform (870) has self-expanded back to anon-compressed state. Buttress assemblies (100, 110) remain secured toanvil (60) and staple cartridge (70), respectively. Heads (882, 884)remain captured between buttress assemblies (100, 110) remain secured toanvil (60) and staple cartridge (70), respectively. Fractured stem (864)remains disposed in platform (870). During the transition from the stageshown in FIG. 56B to the stage shown in FIG. 56C, friction between thematerial of stem (864) and platform (870) provides a firm enough grip onstem (864) such that the portions of stem (864) that were initiallypositioned in platform (870) (i.e., at the stage shown in FIG. 56A)remain in platform (870). In other words, stem (864) will fracture atleast once during closure of end effector (40) (FIG. 56A to FIG. 56B);and fracture at least one more time during opening of end effector (40)(FIG. 56B to FIG. 56C). It should be understood that, at the stage shownin FIG. 56C, buttress assemblies (100, 110) are fully secured to endeffector (40). End effector (40) is then ready for use in a surgicalprocedure as described above.

2. Exemplary Buttress Applier Cartridge with Retainers Disposed OverPlatform

FIG. 57 shows yet another exemplary alternative buttress appliercartridge (1100) that may be used to support and protect one or morebuttress assemblies (160). Cartridge (1100) may also be used to easilyload one or more buttress assemblies (160) on end effector (40).Cartridge (1100) of this example includes an open end (1102) and aclosed end (1104) defined by a housing (1110). Cartridge (1100) furtherincludes and a platform (1120) supporting a buttress assembly (160).While only one buttress assembly (160) is shown in FIG. 57, it should beunderstood that a mirror image buttress assembly (160) may be providedon the underside of platform (1120), such that cartridge (1100) maycarry upper and lower buttress assemblies (160) just like other buttressapplier cartridges carry buttress assemblies (100, 110) in otherexamples described herein. Alternatively, cartridge (1100) may beconfigured to support and release only one buttress assembly (160). Insuch versions, the single buttress assembly (160) may be configured tobe applied to underside (65) of anvil (60) or deck (73) of staplecartridge (70).

Platform (1120) of the present example comprises a body (1122) and aplurality of retainers (1140) positioned on body (1122). Retainers(1140) are arranged in an array such that retainers (1140) are generallyequidistantly spaced from each other along the surfaces of buttressassembly (160). As described in further detail below, retainers (1140)releasably secure buttress assembly (160) to platform (1120). In thepresent example, cartridge (1100) lacks arms (252). In some otherversions, retainers (1140) are provided as a supplement to arms (252).It should therefore be understood that retainers (1140) may be used incombination with other features such as arms (252).

As best seen in FIGS. 58A-58C, buttress assembly (160) comprises a body(162) and an adhesive layer (164). Body (162) includes a plurality ofintegral filaments (166) extending downwardly therefrom. Each filament(166) is associated with a corresponding retainer (1140) as will bedescribed in greater detail below. Aside from the inclusion of filaments(166), buttress assembly (160) may be configured and operable just likebuttress assemblies (100, 110) described above.

As also best seen in FIGS. 58A-58C, platform (1120) of the presentexample comprises a rigid base (1122) that defines a plurality ofopenings (1124). Each opening (1124) is associated with a correspondingretainer (1140) as will be described in greater detail below.

Each retainer (1140) comprises an annular base (1141) and a set of arms(1142) that are pivotably coupled with annular base (1141) viarespective living hinges. Each annular base (1141) is secured to rigidbase (1112) of platform in coaxial alignment with corresponding openings(1124). Each arm (1142) includes a filament engaging feature (1144) anda latching feature (1146). While two arms (1142) may be seen in FIGS.58A-58C, it should be understood that each retainer (1140) may includeany suitable number of arms (1142). It should also be understood thatarms (1142) may be equidistantly spaced from each other in an angulararray about the vertical axis passing through the center of opening(1124) and the center of annular base (1141).

FIG. 58A shows retainer (1140) engaging buttress assembly (160) beforecartridge (1100) is engaged by end effector (40). At this stage,filament (166) is captured by filament engaging features (1144) of arms(1142). Arms (1142) are resiliently biased to maintain this engagement,such that filament engaging features (1144) together clamp againstfilament (166). Retainers (1140) thus secure buttress assembly (160) toplatform (1120).

FIG. 58B shows anvil (60) clamping buttress assembly (160) againstplatform (1120). The force applied by anvil (60) causes arms (1142) todeflect downwardly. During this movement, filament engaging features(1144) disengage filament (166), thereby releasing filament (166). Alsoduring this movement, latching features (1146) engage base (1122). Itshould be understood that arms (1142) may deform during the transitionfrom the state shown in FIG. 58A to the state shown in FIG. 58B in orderto enable latching features (1146) to pass through opening (1124) toengage base (1122). At this stage, adhesive layer (164) has adheredbuttress assembly (160) to anvil (60) and latching features (1146) havesecured retainer (1140) in a collapsed configuration. With buttressassembly (160) adhered to anvil (160) and released from retainer (1140),buttress assembly (160) may be freely pulled away from platform (1120)as end effector (40) is opened as shown in FIG. 58C. Retainer (1140)remains in the collapsed configuration as buttress assembly (160) ispulled away from platform (1120).

When anvil (60) is driven downwardly against buttress assembly (160) andplatform (1120) as shown in FIG. 58B, staple cartridge (70) may besimultaneously driven upwardly against platform (1120) or some otherportion of cartridge (1110). Regardless of whether cartridge (1110)includes features enabling a similar buttress assembly (160) to beapplied to deck (73) of staple cartridge (70), cartridge (1100) mayinclude features that enable retainers (1140) to reach the collapsedconfiguration shown in FIG. 58B without interference from deck (73) ofstaple cartridge (70). Various suitable ways in which cartridge (1100)may prevent upward clamping forces exerted by staple cartridge (70) frominterfering with the collapse of retainers (1140) during closure of endeffector (40) will be apparent to those of ordinary skill in the art inview of the teachings herein.

XIII. EXEMPLARY FEATURES TO CONTROL AND INDICATE HUMIDITY CONDITIONS INBUTTRESS APPLIER CARTRIDGE

Some versions of buttress assemblies (100, 110) may include featuresthat are sensitive to humidity conditions. For instance, the materialforming body (102, 112) may be sensitive to humidity conditions in a waysuch that the effectiveness of body (102, 112) is adversely affectedwhen body (102, 112) is exposed to humidity for a prolonged period.Similarly, the material forming adhesive layer (104, 114) may besensitive to humidity conditions in a way such that the effectiveness ofadhesive layer (104, 114) is adversely affected when adhesive layer(104, 114) is exposed to humidity for a prolonged period. It maytherefore be desirable to incorporate one or more features into abuttress applier cartridge that is/are configured to prevent buttressassemblies (100, 110) from being exposed to humidity for prolongedperiods. In addition, it may be desirable to incorporate one or morefeatures into a buttress applier cartridge that is/are configured toindicate if buttress assemblies (100, 110) have been exposed to humidityfor prolonged periods. If such an indicator shows that buttressassemblies (100, 110) have been exposed to humidity for prolongedperiods, the operator may avoid using those particular buttressassemblies (100, 110).

FIG. 59 shows an exemplary buttress applier cartridge (1700) thatincludes housings (1710, 1718), a platform (1720) supporting a buttressassembly (100), and a plurality of retention features (1752). Retentionfeatures (1752) are configured to releasably secure buttress assembly(100) to platform (1720); and may be configured like any of the variousretention features described herein. Platform (1720) includes aplurality of fins (1722). Fins (1722) are configured to fit within thesidewalls defining channel (62) to ensure that anvil (60) is properlyaligned with buttress assembly (100) as anvil (60) is closed down towardbuttress assembly (100) and platform (1720). It should also beunderstood that the underside of platform (1720) (i.e., the sidecarrying buttress assembly (110), associated with staple cartridge(70)), may also include fins (1722). Fins (1722) on the underside ofplatform (1720) may be sized and arranged to fit in channel (72) ofstaple cartridge (70). Moreover, as will be described in greater detailbelow, fins (1722) on the underside of platform (1720) may be configuredto prevent cartridge (1700) from being used with a staple cartridge (70)that has already been fired.

Cartridge (1700) of the present example further includes a plurality ofindicator beads (1742) that are viewable through a window (1712) formedin housing (1710). Indicator beads (1742) are formed of a color-changingdesiccant material. In particular, beads (1742) are configured toreflect a first color when beads (1742) are in a substantially drystate; and a second color when beads (1742) are in a wet state. Beads(1742) may transition to a wet state in response to exposure to humiditythat is above a threshold that is suitable for buttress assemblies (100,110). In some versions, beads (1742) will maintain the second color evenif the humidity level later drops back below the threshold level. Beads(1742) will thus provide visual indication to the user to indicate thatbuttress assemblies (100, 110) have been subject to an unacceptablelevel of humidity. Of course, beads (1742) may also transition from thefirst color to the second color if beads (1742) are otherwise exposed tofluid, such as spilled medical fluids, bodily fluids from a patient,etc. Various materials that may be used to form beads (1742) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Cartridge (1700) of the present example further includes a cover (1730)that may be removably secured to housings (1710, 1718). Cover (1730)includes an upper panel (1732) and a lower panel (1734) that are coupledtogether to define a “U” shape. Cover (1730) is sized and configured tocover the recesses in which platform (1720) and buttress assemblies(100, 110) are disposed when cover (1730) is secured to housings (1710,1718). Cover (1730) may thus protect buttress assemblies (100, 110) upuntil an operator is ready to use cartridge (1700). To remove cover(1730), the operator may simply pull cover (1730) away from cartridge(1700). By way of example only, panels (1732, 1734) may be resilientlybiased toward each other such that panels (1732, 1734) are oriented tobe non-parallel with each other. Thus, panels (1732, 1734) may bedeflected away from each other to reach a parallel state when cover(1730) is engaged with housings (1710, 1718), such that panels (1732,1734) resiliently bear against housings (1710, 1718) to provide a securefit through friction. Various other suitable configurations that may beused to form cover (1730), and to secure cover (1730) to housings (1710,1718), will be apparent to those of ordinary skill in the art in view ofthe teachings herein. It should also be understood that cover (1730) maybe used with any of the buttress applier cartridges described herein,such that cover (1730) is not at all limited to cartridge (1700).

In some versions, cover (1730) comprises a desiccant material that isconfigured to absorb moisture (e.g., from humidity) and thereby preventthat moisture from reaching buttress assemblies (100, 110). In additionor in the alternative, desiccant material may be incorporated into thematerial forming platform (1720), the material forming housing (1710),packets or compartments located within a cavity defined by housing(1710, 1718), and/or in various other suitable locations/configurations.By way of example only, silica gel may be included in packets that arelocated within a cavity defined by housing (1710, 1718). Other suitabledesiccant materials that may be incorporated into cartridge (1700) willbe apparent to those of ordinary skill in the art in view of theteachings herein. Similarly, various other ways in which one or moredesiccant materials may be incorporated into cartridge (1700) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

XIV. EXEMPLARY FEATURES TO PREVENT USE OF BUTTRESS APPLIER CARTRIDGEWITH SPENT STAPLE CARTRIDGE

In the present example, after a staple cartridge (70) has been actuatedonce, that staple cartridge (70) cannot be used again in the samesurgical procedure. This is because all of the staples (90) in staplecartridge (70) will have been deployed, such that a spent staplecartridge (70) will be unable to apply more staples (90). Instrument(10) may include various features that are sensitive to the spent stateof a staple cartridge (70), such that instrument may prevent firing beam(82) from being actuated as second time through a spent staple cartridge(70). In view of this, it may be desirable to prevent an operator fromimproperly or inadvertently using a buttress applier cartridge to applybuttress assemblies (100, 110) to an end effector (40) that has a spentstaple cartridge (70) loaded in lower jaw (50).

To that end, FIGS. 60-61 show exemplary features that may be readilyincorporated into any of the buttress applier cartridges describedherein to prevent the buttress applier cartridge from being used toapply buttress assemblies (100, 110) to an end effector (40) that has aspent staple cartridge (70) loaded in lower jaw (50). In particular,FIGS. 60-61 show a platform (1870) that has a plurality of integral,downwardly extending rigid fins (1872). Fins (1872) of this example aresubstantially identical to fins (1722) described above, such that fins(1872) are sized and configured to fit in channel (72) of staplecartridge (70). It should therefore be understood that fins (1872) mayassist in ensuring proper alignment between buttress assembly (110) andstaple cartridge (70).

Fins (1872) will also provide a lockout to prevent full closure of anend effector (40) that includes a spent staple cartridge (70). As shownin FIG. 60, in a non-spent staple cartridge (70), wedge sled (78) islocated at a proximal position. Fins (1872) are configured andpositioned such that no fin (1872) will engage the proximally positionedwedge sled (78) when end effector (40) is closed on buttress assemblies(100, 110) and platform (1870). In other words, fins (1872) will notprevent full closure of end effector (40) about buttress assemblies(100, 110) and platform (1870) when staple cartridge (70) is in anon-spent state. However, FIG. 61 shows how wedge sled (78) ispositioned distally in a spent staple cartridge (70); and how one of thefins (1872) will engage the distally positioned wedge sled (78) toprevent full closure of end effector (40) about buttress assemblies(100, 110) and platform (1870) when staple cartridge (70) is in a spentstate. It should therefore be understood that fins (1872) will preventthe operator from being able to apply buttress assembly (110) to deck(73) of a spent staple cartridge (70). Moreover, by physicallyobstructing full closure of end effector (40) about buttress assemblies(100, 110), fins (1872) will provide the operator with visual andtactile feedback indicating that the operator is improperly attemptingto use an end effector (40) with a spent staple cartridge (70).

While platform (1870) only includes downwardly extending fins (1872) inthis example, it should be understood that platform (1872) may alsoinclude upwardly extending fins like fins (1722) described above. To theextent that such upwardly extending fins may not prevent full closure ofend effector (40) about buttress assemblies (100, 110) and platform(1870) when staple cartridge (70) is in a spent state, the upwardlyextending fins may nevertheless promote proper alignment between endeffector (40) and buttress assemblies (100, 110) as described above.

XV. EXEMPLARY END EFFECTOR ALIGNMENT FEATURES FOR BUTTRESS APPLIERCARTRIDGE

In some instances, it may be desirable to configure buttress assembly(100) such that the lateral width of buttress assembly (100) closelymatches the lateral width of underside (65) of anvil (60). Likewise, itmay be desirable to configure buttress assembly (110) such that thelateral width of buttress assembly (110) closely matches the lateralwidth of deck (73) of anvil (70). Matching these widths may presentlittle to no margin of error with respect to alignment of end effector(40) with buttress assemblies (100, 110). It may therefore be desirableto provide features that ensure or otherwise promote proper alignment ofend effector (40) with buttress assemblies (100, 110). Such alignmentmay include proper lateral positioning of end effector along a lateralplane (i.e., a plane that is parallel to the planes defined by buttressassemblies (100, 110)). Such alignment may also include proper “yaw”positioning about an axis that is perpendicular to the same lateralplane (i.e., a plane that is parallel to the planes defined by buttressassemblies (100, 110)). Several examples of features that may be used toensure or otherwise promote proper alignment of end effector (40) withbuttress assemblies (100, 110) are described in greater detail below,while other examples will be apparent to those of ordinary skill in theart in view of the teachings herein.

FIG. 62 shows an exemplary buttress applier cartridge (1400) that may beused to support and protect upper and lower buttress assemblies (1420).Cartridge (1400) may also be used to easily load upper and lowerbuttress assemblies (180) on end effector (40). Cartridge (1400)includes a housing (1410) and a platform (1420) supporting at least onebuttress assembly (180). Buttress assembly (180) may be configured andoperable just like any other buttress assembly described herein, exceptfor the differences specifically noted below. It should also beunderstood that buttress assembly (180) may be releasably secured toplatform (1420) in accordance with any of the teachings herein relatingto securing of buttress assemblies to platforms.

Buttress applier cartridge (1400) is configured to be used with an endeffector (40) that incorporates anvil (1460) in place of anvil (60).Anvil (1460) is identical to anvil (60) except that anvil (1460)includes a first marking (1462) and a second marking (1464). Firstmarking (1462) is positioned at the distal end of anvil (1460), extendslongitudinally, and is laterally centered along the width of anvil(1460). First marking (1462) is configured to correspond with a firstmarking (1412) on housing (1410). First marking (1462) is laterallypositioned to be centered along the width of the recess in whichbuttress assembly (180) is disposed. Thus, in order to ensure that anvil(1460) (and, hence, end effector (40)) has proper lateral alignment withcartridge (1400), the operator may view the positions of markings (1412,1462) in relation to each other to confirm that markings (1412, 1462)are properly aligned with each other.

Second marking (1464) extends cross the width of anvil (1460) and isoriented perpendicularly relative to the longitudinal axis of anvil(1460). Second marking (1464) is configured to correspond with secondmarkings (1414) on housing (1410). Second markings (1414) are located ata predetermined position along the length of the recess in whichbuttress assembly (180) is disposed. This position is located such thatwhen marking (1464) is aligned with markings (1414), a proper length ofbuttress assembly (180) and platform (1420) have been received betweenanvil (1460) and staple cartridge (70). Thus, in order to further ensurethat end effector (40) has been advanced to a proper longitudinalposition in relation to cartridge (1400), the operator may view thepositions of markings (1414, 1464) in relation to each other to confirmthat markings (1414, 1464) are properly aligned with each other.

Platform (1420) of the present example further includes markings (1422,1424) that assist in proper positioning and alignment of end effector(40) relative to cartridge (1400). In particular, platform (1420)includes a marking (1422) in the form of a line that extendslongitudinally along the lateral center of platform (1420). Marking(1422) thus aligns with marking (1412) of housing (1410). It shouldtherefore be appreciated that marking (1422) may assist the operator inaligning marking (1462) with marking (1412), such that the operator mayobserve marking (1422) as representing the same lateral position asmarking (1412). It should also be understood that, in versions wheremarking (1422) is included, marking (1412) may simply be omitted. Inaddition to including marking (1422), platform (1424) includes markings,which include an array of longitudinally extending lines that areparallel to marking (1422) and that are equidistantly laterally offsetfrom marking (1422). Markings (1422) may assist the operator inachieving a proper yaw orientation of end effector (40) relative tocartridge (1400). In particular, the operator may observe thepositioning of the lateral edges of anvil (1460) in relation to markings(1422) to ensure that the lateral edges of anvil (1460) remain parallelwith markings (1422).

In addition to helping ensure proper yaw orientation of end effector(40) relative to cartridge (1400), markings (1422) may also help toensure proper yaw orientation of buttress assembly (180) on platform(1420). In particular, buttress assembly (180) of this example includesa plurality of markings (182) in the form of longitudinally extendinglines that are equidistantly spaced apart across the width of buttressassembly (180). In the present example, the spacing of markings (182) iscloser than the spacing of markings (1422) to promote easiervisualization of buttress assembly (180) on platform (1420), though itshould be understood that the spacings may have any other suitablerelationship. Markings (182) of buttress assembly (180) may be viewed inrelation to markings (1422) of platform (1420) to ensure that markings(182) are parallel with markings (1422). If markings (182) are notparallel with markings (1422) (e.g., as shown in FIG. 62), this mayindicate that buttress assembly (180) does not have a proper yaworientation on platform (1420), such that cartridge (1400) should bediscarded. Markings (182) of buttress assembly (180) may also be viewedin relation to the lateral edges of anvil (1460) to ensure that buttressassembly (180) has a proper yaw orientation on anvil (1460). As shown inFIG. 63, markings (182) may provide visual emphasis to indicate whenbuttress assembly (180) does not have proper yaw orientation on anvil(1460). If the operator observes this mis-orientation, the operator bypeel buttress assembly (180) away from anvil (1460) and apply anotherbuttress assembly (180) to anvil (1460).

XVI. EXEMPLARY FEATURES TO INDICATE USED STATE OF BUTTRESS APPLIERCARTRIDGE

Some surgical procedures may call for the use of several buttressapplier cartridges since end effector (40) may need to be actuatedrepeatedly in order to complete a surgical task. This may create ascenario in an operating room where spent buttress applier cartridgesand unspent buttress applier cartridges are present in the vicinity ofeach other, causing a potential for inadvertent commingling andconfusion. In some cases, an operator may attempt to use an alreadyspent buttress applier cartridge to apply buttress assemblies (100, 110)to an end effector (40); and may fail to realize that the buttressapplier cartridge did not in fact have any buttress assemblies (100,110) loaded on it before the operator then actuates end effector (40) inthe patient. It may therefore be desirable to incorporate one or morefeatures into a buttress applier cartridge in order to enable anoperator to more readily ascertain whether the buttress appliercartridge has already been used to apply buttress assemblies (100, 110)to an end effector (40). The following discussion provides severalmerely illustrative examples of features that may be used to readilyindicate the spent state of a buttress applier cartridge. Furtherexamples will be apparent to those of ordinary skill in the art in viewof the teachings herein.

A. Exemplary Electrically Activated Indicators

FIGS. 64A-64B show components that may be readily incorporated into anyof the buttress applier cartridges described herein to provide anelectrical signal in response to use of the buttress applier cartridgeto apply buttress assemblies (100, 110) to an end effector (40). Inparticular, FIGS. 64A-64B show a base (1770), a layer of medium (1780),and a buttress assembly (100) laid over medium (1780). In somevariations, another layer is interposed between buttress assembly (100)and medium (1780). Such an intermediate layer may be substantiallynon-compressible such that the intermediate layer will efficientlytransfer compression forces from buttress assembly (100) to medium(1780) (e.g., when an anvil (60) clamps down on buttress assembly(100)).

Base (1770) may be incorporated into any of the various platformsdiscussed herein. Medium (1780) of this example comprises a flowable,electrically conductive material. The material forming medium (1780) isconfigured to maintain a flat structural configuration as shown in FIG.64A when medium (1780) is not being pressed against base (1770).However, when medium (1780) is pressed against base (1770), such as whenan anvil (60) clamps buttress assembly (100) against base (1770) and anunderlying platform, medium (1780) will flow into a recess (1772) formedin base (1770) as shown in FIG. 64B. Medium (1780) will then stay inrecess (1772).

Various suitable materials that may be used to form medium (1780) willbe apparent to those of ordinary skill in the art in view of theteachings herein. By way of example only, medium (1780) may comprise anadhesive material that removably adheres buttress assembly (100) to base(1770). For instance, medium (1780) may comprise PEG blends, PVP/PEGblends, PLC/PGA copolymers, TMC/PGA copolymers, etc., with one or moreadditives that make the adhesive material electrically conductive. Insome versions, medium (1780) comprises the same adhesive material(albeit with electrically conductive material added) that is used toapply buttress assemblies (100, 110) to underside (65) of anvil (60) anddeck (73) of staple cartridge (70). By using a similar adhesive materialfor medium (1780), the flow of medium (1780) into recesses (1772) mayoccur substantially contemporaneously with the flow of adhesive materialforming adhesive layers (102, 112) into the various recesses and othersurface features found in underside (65) of anvil (60) and deck (73) ofstaple cartridge (70). In other words, the flow of medium (1780) intorecesses (1772) may be indicative of the flow of adhesive materialforming adhesive layers (102, 112) into the various recesses and othersurface features found in underside (65) of anvil (60) and deck (73) ofstaple cartridge (70). Other suitable materials that may be used to formmedium (1780) will be apparent to those of ordinary skill in the art inview of the teachings herein.

In the present example, a pair of electrodes (1774, 1776) are fixedlypositioned on opposite sides of recess (1772). Electrodes (1774, 1776)include conductive contacts that are exposed to the space within recess(1772). Electrodes (1774, 1776) are coupled with a voltage source (notshown) (e.g., a battery) via wires (1778), such that electrode (1774)provides a positive charge and electrode (1776) provides a negativecharge. It should be understood from the foregoing that, it the stateshown in FIG. 64A, there is nothing to provide electrical continuitybetween electrodes (1774, 1776), such that electrical current will notflow through wires (1778). However, once medium (1780) enters recess(1772) as shown in FIG. 64B and thereby provides a path for electricalcommunication between electrodes (1774, 1776), electrical current willflow through wires (1778).

Various suitable indicator features may be in electrical communicationwith wires (1778) such that an indicator is electrically activated inresponse to entry of medium (1780) in recess (1772). By way of exampleonly, such an indicator feature may comprise a light source such as anLED, etc. that is viewable from the exterior of the buttress appliercartridge. In such versions, since the light source is not illuminateduntil medium (1780) is compressed by closure of anvil (60), theillumination of the light source may provide a clear visual indicationthat the buttress applier cartridge has already been used to applybuttress assembly (100) to anvil (60). Since medium (1780) will remainin recess (1772), the light source may remain illuminated until thevoltage source runs out of power or the circuit is otherwiseinterrupted. By way of example only, wires (1778) may be incommunication with any of the various indicator features described inU.S. patent application No. [ATTORNEY DOCKET NO. END7818USNP.0630118],entitled “Surgical Stapler Buttress Applicator with Data Communication,”filed on even date herewith, the disclosure of which is incorporated byreference herein. Other suitable indicators that may be in communicationwith wires (1778) to indicate a spent state of a buttress appliercartridge will be apparent to those of ordinary skill in the art in viewof the teachings herein.

B. Exemplary Fluid Transfer Indicators

FIG. 65 shows another exemplary alternative buttress applier cartridge(1800) that may be used to apply buttress assemblies (100, 110) to anend effector (40). Cartridge (1800) of this example includes a housing(1810) and a platform (1820). Platform (1820) includes a series ofindicator assemblies (1830) embedded within the body (1822) of platform(1820). As best seen in FIGS. 66A-66B, each indicator assembly (1830)includes a first reservoir (1832), a second reservoir (1834), and aconduit (1836) extending between reservoirs (1832, 1834). Each set ofreservoirs (1832, 1834) and conduit (1836) defines a closed fluidcircuit that contains a fixed volume of liquid (1838).

In the present example, body (1822) is formed of a material that iscompressible from an expanded thickness (FIG. 66A) to a compressedthickness (FIG. 66B); and is configured to maintain the compressedthickness after body (1822) has been compressed (e.g., even after endeffector (40) opens to release platform (1820)). Reservoir (1832) isconfigured to compress with platform (1820), such that the volume ofreservoir (1832) will decrease as platform (1820) is compressed.Reservoir (1834) includes an upper portion that is exposed relative tobody (1822), such that an operator may visually observe reservoir(1834). When platform (1820) is in the uncompressed state as shown inFIG. 66A, none of liquid (1838) is positioned in reservoir (1834). Asshown in the transition from FIG. 66A to FIG. 66B, some of liquid (1838)will be pressed out of reservoir (1832) when anvil (60) compresses body(1822) of platform (1820). Liquid (1838) will then flow into reservoir(1834). It should be understood that reservoir (1834) may include one ormore vent openings (not shown) that will enable air to escape fromreservoir (1834) when liquid (1838) is driven into reservoir (1834).

With reservoir (1834) filled with liquid (1838) as shown in FIG. 66B,the operator may readily view the presence of liquid (1838) in reservoir(1834) as a visual indication that the cartridge (1800) has been spent(i.e., that cartridge (1800) no longer has buttress assemblies (100,110)). Since body (1822) is configured to maintain a compressed stateeven after platform (1820) is released from end effector (40), liquid(1838) will remain visible in reservoir (1834) to continue indicatingthat cartridge (1800) has been spent. It should be understood that thematerials forming liquid (1838) and body (1822) may be selected toprovide a strong contrast, thereby enhancing visibility of liquid (1838)in reservoir (1834).

In addition to providing a visual indication of whether cartridge (1800)has been spent, indicator assemblies (1830) may provide visual feedbackto indicate whether the operator has applied sufficient clamping forcewith end effector (40) in order to successfully transfer buttressassemblies (100, 110) from platform (1820) to end effector (40). Inparticular, platform (1820) and indicator assemblies (1830) may beconfigured such that an operator must provide a clamping force with endeffector (40) above a certain threshold before liquid (1838) will reachreservoir (1834). Thus, if an operator attempts to clamp end effector(40) on buttress assemblies (100, 110) and platform (1820) yet fails toapply a sufficient clamping force with end effector (40), liquid (1838)will not be driven from reservoir (1832) to reservoir (1834). Theoperator may thereby determine that the clamping force was insufficientin view of the fact that liquid (1838) is not seen in reservoir (1834).The operator may try again with greater clamping force and then observereservoir (1834) again for the presence of liquid (1838) to determinewhether the additional clamping force was sufficient.

XVII. EXEMPLARY BUTTRESS APPLIER CARTRIDGE WITH FLUID CAPTURE RESERVOIR

Some versions of buttress assemblies (100, 110) may comprise a flowableadhesive material and/or some other flowable material. In some suchversions, the flowable material may flow considerably in response toclamping of end effector (40) on buttress assemblies (100, 110), suchthat the clamping action of end effector (40) drives a flow of adhesivematerial out from buttress assemblies (100, 110) when end effector (40)clamps down on buttress assemblies (100, 110). It may therefore bedesirable to provide features in a buttress applying cartridge to handleexcess flowable adhesive material. To that end, FIG. 67 shows anexemplary buttress applier cartridge (1900) that comprises housings(1910, 1918), and a platform (1920). FIG. 67 shows cartridge (1900) in astate where an end effector (40) has already retrieved buttressassemblies (100, 110) from platform (1920), with an excess of flowablematerial (198) being left on platform (1920). Platform (1920) of thisexample further comprises a plurality of drainage openings (1922) nearthe interface regions of housings (1910, 1918). Drainage openings (1922)are in fluid communication with a cavity (1950) that is defined byhousings (1910, 1918). Thus, drainage openings (1922) allow the flowablematerial (198) to drain through drainage openings (1922) and into cavity(1950). The interiors of housings (1910, 1918) further include baffles(1952) in cavity (1950). Baffles (1952) are configured to assist inretaining the excess flowable material (198) in cavity (199). Othersuitable features that may be incorporated into a buttress appliercartridge to handle excess flowable materials will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

As described in greater detail below, some versions of buttressassemblies (100, 110) may be sensitive to certain environmentalconditions (e.g., high humidity levels, high temperatures, etc.) suchthat the effectiveness of buttress assembly (100, 110) may becompromised after buttress assembly (100, 110) has been sufficientlyexposed to one or more adverse environmental conditions. In some suchversions, flowable material (198) will liquefy in response to sufficientexposure to one or more adverse environmental conditions. If this occursbefore buttress assembly (100, 110) is picked up by an end effector(40), flowable material (198) may simply flow off of buttress body (102,112) and into cavity (199) as described above. In some such instances,buttress assembly (100, 110) may then be rendered inoperable by theabsence of flowable material (198). For instance, buttress assembly(100, 110) may be unable to adhere to end effector (40) in the absenceof flowable material (198).

XVIII. EXEMPLARY PACKAGING FOR BUTTRESS APPLIER CARTRIDGE

It may be desirable to provide a buttress applier cartridge in a sealedpackage that maintains the sterility of the buttress applier cartridge.It may also be desirable to configure such packaging in a way thatprovides an operator with ready indication of whether the seal is beingmaintain or if the seal has been compromised. To that end, FIGS. 68-69show a package (2100) comprising a sealed bag (2120) that contains abuttress applier cartridge (2110). Cartridge (2110) may comprise any ofthe various buttress applier cartridges described herein. As shown inFIG. 68, bag (2120) is filled with air and then sealed, keeping bag(2120) in an inflated state. In the event that the seal is broken, airwill escape bag (2120), such that bag (2120) will transition to adeflated state as shown in FIG. 69. An operator may thus readilydetermine whether the seal of bag (2120) is intact or broken byobserving whether bag (2120) is in an inflated state (FIG. 68) or adeflated state (FIG. 69). In some versions, bag (2120) is resilientlybiased to conform to the shape of cartridge (2110) or to otherwiseshrink in the deflated state, which may make the state of deflation evenmore readily apparent. It should also be understood that the air that isused to fill bag (2120) may contain a characteristic odor to provideolfactory feedback, such that when the operator opens bag (2120), theoperator may observe whether the characteristic odor is present in orderto determine whether bag (2120) had maintained a seal before theoperator opened bag (2120). Bag (2120) may also provide a popping soundwhen the operator opens bag (2120), to provide audible feedback toindicate that the seal had been successfully maintained before theoperator opened bag (2120). Other suitable ways in which package (2110)may be modified will be apparent to those of ordinary skill in the artin view of the teachings herein.

XIX. EXEMPLARY FEATURES IN BUTTRESS APPLIER CARTRIDGE TO REACT TOENVIRONMENTAL CONDITIONS

In some instances, it may be desirable to discourage or prevent anoperator from loading a buttress assembly (100, 110) onto end effector(40) when that buttress assembly (100, 110) has been exposed to certainenvironmental conditions that may compromise the effectiveness ofbuttress assembly (100, 110). For instance, it may be desirable todiscourage or prevent an operator from loading a buttress assembly (100,110) onto end effector (40) when that buttress assembly (100, 110) hasbeen exposed to a humidity level above a certain threshold, otherexposure to moisture, a temperature above a certain threshold, and/orsome other environmental condition(s) that may compromise theeffectiveness of buttress assembly (100, 110). By way of example only,the material forming body (102, 112) may be sensitive to certainenvironmental conditions in a way such that the effectiveness of body(102, 112) is adversely affected when body (102, 112) is exposed tocertain environmental conditions for a prolonged period. Similarly, thematerial forming adhesive layer (104, 114) may be sensitive to certainenvironmental conditions in a way such that the effectiveness ofadhesive layer (104, 114) is adversely affected when adhesive layer(104, 114) is exposed to certain environmental conditions for aprolonged period. The following examples provide various features thatmay be incorporated into a buttress applier cartridge in order todiscourage or prevent an operator from loading a buttress assembly (100,110) onto end effector (40) when that buttress assembly (100, 110) hasbeen exposed to certain environmental conditions. It should beunderstood that the features described below may be readily incorporatedinto any of the various buttress applier cartridges described herein.

A. Exemplary Features to Control and Visually Indicate EnvironmentalCondition Exposure in Buttress Applier Cartridge

One way in which a buttress applier cartridge may discourage an operatorfrom loading a buttress assembly (100, 110) onto end effector (40) whenthat buttress assembly (100, 110) has been exposed to certainenvironmental conditions is to provide a visual indication to theoperator, indicating to the operator that buttress assembly (100, 110)has been exposed to certain environmental conditions. If such anindicator shows that buttress assemblies (100, 110) have been exposed tocertain environmental conditions for prolonged periods, the operator mayavoid using those particular buttress assemblies (100, 110). It may alsobe desirable to incorporate one or more features into a buttress appliercartridge that is/are configured to prevent buttress assemblies (100,110) from being exposed to certain environmental conditions forprolonged periods. The following examples are provided in the context ofexcess humidity as an adverse environmental condition, though it shouldbe understood that many of the same teachings may be readily applied toexcess temperature as an adverse environmental condition and/or otherkinds of adverse environmental conditions.

As noted above, FIG. 59 shows an exemplary buttress applier cartridge(1700) that includes housings (1710, 1718), a platform (1720) supportinga buttress assembly (100), and a plurality of retention features (1752).Retention features (1752) are configured to releasably secure buttressassembly (100) to platform (1720); and may be configured like any of thevarious retention features described herein. Platform (1720) includes aplurality of fins (1722). Fins (1722) are configured to fit within thesidewalls defining channel (62) to ensure that anvil (60) is properlyaligned with buttress assembly (100) as anvil (60) is closed down towardbuttress assembly (100) and platform (1720). It should also beunderstood that the underside of platform (1720) (i.e., the sidecarrying buttress assembly (110), associated with staple cartridge(70)), may also include fins (1722). Fins (1722) on the underside ofplatform (1720) may be sized and arranged to fit in channel (72) ofstaple cartridge (70). It should be understood that fins (1722) aremerely optional.

Cartridge (1700) of the present example further includes a plurality ofindicator beads (1742) that are viewable through a window (1712) formedin housing (1710). Indicator beads (1742) are formed of a color-changingdesiccant material. In particular, beads (1742) are configured toreflect a first color when beads (1742) are in a substantially drystate; and a second color when beads (1742) are in a wet state. Beads(1742) may transition to a wet state in response to exposure to humiditythat is above a threshold that is suitable for buttress assemblies (100,110). In some versions, beads (1742) will maintain the second color evenif the humidity level later drops back below the threshold level. Beads(1742) will thus provide visual indication to the user to indicate thatbuttress assemblies (100, 110) have been subject to an unacceptablelevel of humidity. Of course, beads (1742) may also transition from thefirst color to the second color if beads (1742) are otherwise exposed tofluid, such as spilled medical fluids, bodily fluids from a patient,etc. Various materials that may be used to form beads (1742) will beapparent to those of ordinary skill in the art in view of the teachingsherein. It should also be understood that buttress assemblies (100, 110)may include materials that change color or otherwise change appearancein response to exposure to adverse environmental conditions.

Cartridge (1700) of the present example further includes a cover (1730)that may be removably secured to housings (1710, 1718). Cover (1730)includes an upper panel (1732) and a lower panel (1734) that are coupledtogether to define a “U” shape. Cover (1730) is sized and configured tocover the recesses in which platform (1720) and buttress assemblies(100, 110) are disposed when cover (1730) is secured to housings (1710,1718). Cover (1730) may thus protect buttress assemblies (100, 110) upuntil an operator is ready to use cartridge (1700). To remove cover(1730), the operator may simply pull cover (1730) away from cartridge(1700). By way of example only, panels (1732, 1734) may be resilientlybiased toward each other such that panels (1732, 1734) are oriented tobe non-parallel with each other. Thus, panels (1732, 1734) may bedeflected away from each other to reach a parallel state when cover(1730) is engaged with housings (1710, 1718), such that panels (1732,1734) resiliently bear against housings (1710, 1718) to provide a securefit through friction. Various other suitable configurations that may beused to form cover (1730), and to secure cover (1730) to housings (1710,1718), will be apparent to those of ordinary skill in the art in view ofthe teachings herein. It should also be understood that cover (1730) maybe used with any of the buttress applier cartridges described herein,such that cover (1730) is not at all limited to cartridge (1700).

In some versions, cover (1730) comprises a desiccant material that isconfigured to absorb moisture (e.g., from humidity) and thereby preventthat moisture from reaching buttress assemblies (100, 110). In additionor in the alternative, desiccant material may be incorporated into thematerial forming platform (1720), the material forming housing (1710),packets or compartments located within a cavity defined by housing(1710, 1718), and/or in various other suitable locations/configurations.By way of example only, silica gel may be included in packets that arelocated within a cavity defined by housing (1710, 1718). Other suitabledesiccant materials that may be incorporated into cartridge (1700) willbe apparent to those of ordinary skill in the art in view of theteachings herein. Similarly, various other ways in which one or moredesiccant materials may be incorporated into cartridge (1700) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

B. Exemplary Lockout for Buttress Applier Cartridge

In some instances, it may be desirable to physically prevent an operatorfrom loading a buttress assembly (100, 110) onto end effector (40) whenthat buttress assembly (100, 110) has been exposed to certainenvironmental conditions that may compromise the effectiveness ofbuttress assembly (100, 110). For instance, it may be desirable toprevent an operator from loading a buttress assembly (100, 110) onto endeffector (40) when that buttress assembly (100, 110) has been exposed toa humidity level above a certain threshold, other exposure to moisture,a temperature above a certain threshold, and/or some other adverseenvironmental condition(s). To that end, FIG. 70 shows an exemplaryalternative buttress applier cartridge (2700) that includes a housing(2702) and a platform (2720) with a buttress assembly (100) disposed onplatform (2720). Housing (2702), platform (2720), and buttress assembly(100) may be configured and operable in accordance with any of thevarious teachings herein. Similarly, buttress assembly (100) may beselectively retained on platform (2720) in accordance with any of thevarious teachings herein.

Cartridge (2700) of the present example further comprises a lockoutpanel (2750). Lockout panel (2750) is pivotably coupled with housing(2702) via a pin (2760). A torsion spring (2762) is positioned about pin(2760) and is configured to resiliently bias lockout panel (2750) to theposition shown in FIG. 70. In this position, lockout panel (2750) spansthe gap defined between the prongs of housing (2702) and thereby coversbuttress assembly (100). Lockout panel (2750) thus prevents an endeffector (40) from engaging buttress assembly (100) when lockout panel(2750) is in the position shown in FIG. 70. However, lockout panel(2750) may be pivoted away from the position shown in FIG. 70 such thatlockout panel (2750) does not cover buttress assembly (100) or otherwiseobstruct access to buttress assembly (100) by end effector (40). Toselectively hold lockout panel (2750) in a non-blocking position,cartridge (2700) includes a latch (2770). Latch (2770) is coupled withhousing (2702) by a coil spring (2772) and is configured to engage alatching feature (2752) of lockout panel (2750) as shown in FIG. 71A.When latch (2770) is engaged with latching feature (2752), latch (2770)is configured to hold lockout panel (2750) in the non-blocking positiondespite the resilient bias provided by torsion spring (2762).

Coil spring (2772) is resiliently biased to assume a compressedconfiguration. When latch (2770) is engaged with latching feature(2752), coil spring (2772) is in a stretched configuration, such thatcoil spring (2772) is under stress. To hold coil spring (2772) in thestressed, stretched configuration, a spacing material (2774) is disposedabout coil spring. Spacing material (2774) is positioned between coilsof coil spring (2772). Under acceptable environmental conditions,spacing material (2774) has sufficient structural integrity to maintainthe spacing between the coils of coil spring (2772), thereby maintainingcoil spring (2772) in the stressed, stretched configuration, therebyholding lockout panel (2750) in the non-blocking position. However,spacing material (2774) is configured to liquefy and/or otherwisedegrade in response to one or more environmental conditions that areadverse to buttress assemblies (100, 110). As shown in FIG. 71B, theliquefaction or other degradation of spacing material (2774) allows coilspring (2772) to return to a compressed configuration, which will pulllatch (2770) out of engagement with latch feature (2752). When latch(2770) is disengaged from latch feature (2752), torsion spring (2762)pivots lockout panel (2750) about pin (2760) to the blocking position asshown in FIG. 70. Thus, cartridge (2700) will prevent the operator fromengaging buttress (100) when cartridge (2700) has been exposed to one ormore environmental conditions that are adverse to buttress (100). Inaddition to blocking access to buttress (100), lockout panel (2750) mayalso include a visual indication (e.g., text reading “do not use,” thecolor red, a stop sign, etc.) to further indicate to the operator thatcartridge (2700) has essentially been rendered inoperable.

Those of ordinary skill in the art will recognize that various kinds ofmaterials may be used to form spacing material (2774). By way of exampleonly, spacing material (2774) may comprise wax, PVP (e.g., for humiditysensitivity), PEG (e.g., for temperature sensitivity), and/or any othersuitable material(s). It should also be understood that cartridge (2700)may be readily modified to deploy lockout panel (2750) to the blockingposition in response to an end effector (40) picking up buttressassembly (100, 110) from platform (2720). Lockout panel (2750) may thusvisually indicate to the operator that cartridge (2700) is spent, andmay further prevent the operator from clamping end effector on an emptyplatform (2720). Such functionality may be provided in addition to or inlieu of deployment of lockout panel (2750) in response to adverseenvironmental conditions.

XX. EXEMPLARY END EFFECTOR ALIGNMENT FEATURES FOR BUTTRESS APPLIERCARTRIDGE

In some instances, it may be desirable to configure buttress assembly(100) such that the lateral width of buttress assembly (100) closelymatches the lateral width of underside (65) of anvil (60). Likewise, itmay be desirable to configure buttress assembly (110) such that thelateral width of buttress assembly (110) closely matches the lateralwidth of deck (73) of anvil (70). Matching these widths may presentlittle to no margin of error with respect to alignment of end effector(40) with buttress assemblies (100, 110). It may therefore be desirableto provide features that ensure or otherwise promote proper alignment ofend effector (40) with buttress assemblies (100, 110). Such alignmentmay include proper lateral positioning of end effector along a lateralplane (i.e., a plane that is parallel to the planes defined by buttressassemblies (100, 110)). Such alignment may also include proper “yaw”positioning about an axis that is perpendicular to the same lateralplane (i.e., a plane that is parallel to the planes defined by buttressassemblies (100, 110)). Several examples of features that may be used toensure or otherwise promote proper alignment of end effector (40) withbuttress assemblies (100, 110) are described in greater detail below,while other examples will be apparent to those of ordinary skill in theart in view of the teachings herein.

FIG. 72 shows a buttress applier cartridge (1500) that includes an upperhousing (1510) and a lower housing (1530), with a platform (1520)supporting buttress assemblies (100, 110). Platform (1520) is capturedbetween housings (1510, 1530). Buttress assemblies (100, 110) may beremovably secured to platform (1520) using any of the various retentionstructures or techniques described herein. In the present example,buttress assembly (110) has a wider lateral width than buttress assembly(100). This is due to the fact that buttress assembly (110) isconfigured to be applied to deck (73) of staple cartridge (70), whichhas a wider lateral width than underside (65) of anvil (60).

Housing (1510) of the present example includes a pair of inner walls(1512) that together define a laterally extending gap. Housing (1532)also includes a pair of walls (1532) that together define a laterallyextending gap. These gaps are sized differently in order to accommodateend effector (40) in only one “roll” orientation (i.e., about thelongitudinal axis of cartridge (1500), to ensure that an operator willnot inadvertently apply buttress assembly (100) to deck (73) andbuttress assembly (110) to underside (65). FIG. 72 shows how lower jaw(50) defines a lateral width “x.” The gap between inner walls (1512) issmaller than that width “x” while the gap between inner walls (1532) islarger than the width “x.” Thus, if an operator positions cartridge(1500) in relation to end effector (40) at a roll orientation that isoff by 180 degrees, such that buttress assembly (100) is facing deck(73) and buttress assembly (110) is facing underside (65), the operatorwill be unable to fully clamp end effector (40) onto buttress assemblies(100, 110) since staple cartridge (70) and lower jaw (50) will not fitin the gap between inner walls (1512).

XXI. EXEMPLARY FEATURES TO CONTROL AND INDICATE HUMIDITY CONDITIONS INBUTTRESS APPLIER CARTRIDGE

Some versions of buttress assemblies (100, 110) may include featuresthat are sensitive to humidity conditions. For instance, the materialforming body (102, 112) may be sensitive to humidity conditions in a waysuch that the effectiveness of body (102, 112) is adversely affectedwhen body (102, 112) is exposed to humidity for a prolonged period.Similarly, the material forming adhesive layer (104, 114) may besensitive to humidity conditions in a way such that the effectiveness ofadhesive layer (104, 114) is adversely affected when adhesive layer(104, 114) is exposed to humidity for a prolonged period. It maytherefore be desirable to incorporate one or more features into abuttress applier cartridge that is/are configured to prevent buttressassemblies (100, 110) from being exposed to humidity for prolongedperiods. In addition, it may be desirable to incorporate one or morefeatures into a buttress applier cartridge that is/are configured toindicate if buttress assemblies (100, 110) have been exposed to humidityfor prolonged periods. If such an indicator shows that buttressassemblies (100, 110) have been exposed to humidity for prolongedperiods, the operator may avoid using those particular buttressassemblies (100, 110).

As noted above, FIG. 59 shows an exemplary buttress applier cartridge(1700) that includes housings (1710, 1718), a platform (1720) supportinga buttress assembly (100), and a plurality of retention features (1752).Retention features (1752) are configured to releasably secure buttressassembly (100) to platform (1720); and may be configured like any of thevarious retention features described herein. Platform (1720) includes aplurality of fins (1722). Fins (1722) are configured and operable justlike fins (624) described above, such that fins (1722) may fit withinthe sidewalls defining channel (62) to ensure that anvil (60) isproperly aligned with buttress assembly (100) as anvil (60) is closeddown toward buttress assembly (100) and platform (1720). It should alsobe understood that the underside of platform (1720) (i.e., the sidecarrying buttress assembly (110), associated with staple cartridge(70)), may also include fins (1722). Fins (1722) on the underside ofplatform (1720) may be sized and arranged to fit in channel (72) ofstaple cartridge (70). Moreover, as will be described in greater detailbelow, fins (1722) on the underside of platform (1720) may be configuredto prevent cartridge (1700) from being used with a staple cartridge (70)that has already been fired.

Cartridge (1700) of the present example further includes a plurality ofindicator beads (1742) that are viewable through a window (1712) formedin housing (1710). Indicator beads (1742) are formed of a color-changingdesiccant material. In particular, beads (1742) are configured toreflect a first color when beads (1742) are in a substantially drystate; and a second color when beads (1742) are in a wet state. Beads(1742) may transition to a wet state in response to exposure to humiditythat is above a threshold that is suitable for buttress assemblies (100,110). In some versions, beads (1742) will maintain the second color evenif the humidity level later drops back below the threshold level. Beads(1742) will thus provide visual indication to the user to indicate thatbuttress assemblies (100, 110) have been subject to an unacceptablelevel of humidity. Of course, beads (1742) may also transition from thefirst color to the second color if beads (1742) are otherwise exposed tofluid, such as spilled medical fluids, bodily fluids from a patient,etc. Various materials that may be used to form beads (1742) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Cartridge (1700) of the present example further includes a cover (1730)that may be removably secured to housings (1710, 1718). Cover (1730)includes an upper panel (1732) and a lower panel (1734) that are coupledtogether to define a “U” shape. Cover (1730) is sized and configured tocover the recesses in which platform (1720) and buttress assemblies(100, 110) are disposed when cover (1730) is secured to housings (1710,1718). Cover (1730) may thus protect buttress assemblies (100, 110) upuntil an operator is ready to use cartridge (1700). To remove cover(1730), the operator may simply pull cover (1730) away from cartridge(1700). By way of example only, panels (1732, 1734) may be resilientlybiased toward each other such that panels (1732, 1734) are oriented tobe non-parallel with each other. Thus, panels (1732, 1734) may bedeflected away from each other to reach a parallel state when cover(1730) is engaged with housings (1710, 1718), such that panels (1732,1734) resiliently bear against housings (1710, 1718) to provide a securefit through friction. Various other suitable configurations that may beused to form cover (1730), and to secure cover (1730) to housings (1710,1718), will be apparent to those of ordinary skill in the art in view ofthe teachings herein. It should also be understood that cover (1730) maybe used with any of the buttress applier cartridges described herein,such that cover (1730) is not at all limited to cartridge (1700).

In some versions, cover (1730) comprises a desiccant material that isconfigured to absorb moisture (e.g., from humidity) and thereby preventthat moisture from reaching buttress assemblies (100, 110). In additionor in the alternative, desiccant material may be incorporated into thematerial forming platform (1720), the material forming housing (1710),packets or compartments located within a cavity defined by housing(1710, 1718), and/or in various other suitable locations/configurations.By way of example only, silica gel may be included in packets that arelocated within a cavity defined by housing (1710, 1718). Other suitabledesiccant materials that may be incorporated into cartridge (1700) willbe apparent to those of ordinary skill in the art in view of theteachings herein. Similarly, various other ways in which one or moredesiccant materials may be incorporated into cartridge (1700) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

XXII. EXEMPLARY BUTTRESS APPLIER CARTRIDGE WITH DATA COMMUNICATION

As noted above, buttress assembly (100) may be applied to the underside(65) of anvil (60), and buttress (110) may be applied to deck (73) ofstaple cartridge (70), before tissue (T₁, T₂) is positioned in endeffector (40), and before end effector (40) is actuated. Because endeffector (40) may be actuated many times during use of instrument (10)in a single surgical procedure, it may be desirable to enable anoperator to repeatedly and easily load buttress assemblies (100) onunderside (65) of anvil (60) during that single surgical procedure. Inother words, because end effector (40) may be actuated many times duringuse of instrument (10) in a single surgical procedure, it may beinsufficient to simply provide anvil (60) pre-loaded with a buttressassembly (100) without facilitating the re-loading of anvil (60) withadditional buttress assemblies (100) after end effector (40) has beenactuated.

Similarly, those of ordinary skill in the art will recognize that staplecartridge (70) will need to be replaced each time end effector (40) isactuated. When end effector (40) is actuated several times during use ofinstrument (10) in a single surgical procedure, several staplecartridges (70) may thus be used during that surgical procedure. It mayseem that each of these staple cartridges (70) may be provided withbuttress assembly (110) pre-loaded on deck (73). However, there are somereasons why it may be undesirable to provide a staple cartridge (70)with buttress assembly (110) pre-loaded on deck (73). In other words, itmay be desirable to provide loading of buttress assembly (110) on deck(73) immediately prior to usage of staple cartridge in the surgicalprocedure, rather than loading buttress assembly (110) on deck (73) asubstantial time prior to the surgical procedure. For instance, buttressassembly (110) may not be compatible with the same sterilizationtechniques as staple cartridge (70), such that it may present processingdifficulties to package staple cartridge (70) with buttress assembly(110) pre-loaded on deck (73). In addition, the material formingbuttress assembly (110) may have certain environmental sensitivitiesthat staple cartridge (70) does not have, such that it may be beneficialto enable buttress assembly (110) and staple cartridge (70) to be storedseparately before use. Moreover, buttress assembly (110) may not bewarranted or otherwise desired in some surgical procedures, such that itmay be desirable to enable a physician to easily choose whether staplecartridge (70) should be loaded with buttress assembly (110) before thatstaple cartridge (70) is used in the surgical procedure.

In view of the foregoing, it may be desirable to enable an operator torepeatedly and easily load buttress assemblies (100, 110) on endeffector (40) on an ad hoc basis during a given surgical procedure. Itmay also be desirable to provide a device that provides support andprotection to buttress assemblies (100, 110) before buttress assemblies(100, 110) are loaded on end effector (40), in addition to that samedevice also enabling buttress assemblies (100, 110) to be easily loadedon end effector. The examples described below relate to cartridgeassemblies that provide such support, protection, and loading ofbuttress assemblies (100, 110). It should be understood that thefollowing examples are merely illustrative. Numerous variations will beapparent to those of ordinary skill in the art in view of the teachingsherein.

FIG. 73 shows an exemplary buttress applier cartridge (3200) that may beused in conjunction with an exemplary alternative surgical stapling andsevering instrument (3300) as shown in FIG. 74. Cartridge (3200) of thisexample comprises a “U” shaped housing (3204) that defines two prongs(3224) having a space therebetween. As described in greater detailbelow, this space is sized to accommodate the length and width of an endeffector (3340) of instrument (3300). A platform (3222) is located inthe space between prongs (3224). A buttress (3202) is supported onplatform (3222).

By way of example only, platform (3222) may comprise a sheet of foammaterial. While only one buttress (3202) is shown on the top side ofplatform (3222) in FIG. 73, it should be understood that anotherbuttress (3201) may be positioned on the underside of platform (3222),as shown in FIGS. 79A-79B. Buttresses (3201, 3202) may be removablysecured to platform (3222) in any suitable fashion, including but notlimited to being secured via an adhesive, resiliently biased retainers,etc. As another merely illustrative example, buttresses (3201, 3202) maybe removably secured to platform (3222) in accordance with at least someof the teachings of U.S. Patent App. No. 62/209,041, entitled “Methodand Apparatus for Applying a Buttress to End Effector of a SurgicalStapler,” filed Aug. 24, 2015, the disclosure of which is incorporatedby reference herein. Other suitable ways in which buttresses (3201,3202) may be removably secured to platform (3222) will be apparent tothose of ordinary skill in the art in view of the teachings herein.

While cartridge (3200) may be used with instrument (10) described above,cartridge (3200) is particularly configured to be used with instrument(3300). Instrument (3300) of this example is configured and operablejust like instrument (10) except for the differences described below. Itshould also be understood that instrument (3300) may be configured andoperable in accordance with at least some of the teachings of U.S.patent application Ser. No. 14/226,142, entitled “Surgical InstrumentComprising a Sensor System,” filed Mar. 26, 32014, the disclosure ofwhich is incorporated by reference herein. As shown in FIG. 74,instrument (3300) of this example comprises a handle assembly (3310)with a display screen (3320), a pistol grip (3322), a pivoting trigger(3324), and a removable battery pack (3328). A shaft assembly (3330)extends distally from handle assembly (3310). A rotary knob (3331) islocated at the proximal end of shaft assembly (3330) and is operable torotate shaft assembly (3330) relative to handle assembly (3310), aboutthe longitudinal axis of shaft assembly (3330). Shaft assembly (3330) ofthis example is substantially identical to shaft assembly (330)described above, except that shaft assembly (3330) of this exampleincludes one or more wires and/or other features that enablecommunication of data from end effector (40) to handle assembly (3310).In some versions, shaft assembly (3330) is selectively removable fromhandle assembly (3310) (e.g., in accordance with the teachings of U.S.patent application Ser. No. 14/226,142 or in any other suitablefashion).

As shown in FIG. 75, an end effector (3340) is positioned at the distalend of shaft assembly (3330). End effector (3330) includes a lower jaw(3350), an anvil (3360), and a staple cartridge (3370) that is removablyreceived in lower jaw (3350). A knife member (3380) is configured totranslate through end effector (3340) to sever tissue that is capturedbetween underside (3365) of anvil (3360) and deck (3373) of staplecartridge (3370). Knife member (3380) also cooperates with a wedge sled(not shown) in staple cartridge (3370) to drive staples from staplecartridge (3370), through the captured tissue, and into formationagainst anvil (3360). In the present example, pivotal movement oftrigger (3324) toward and away from pistol grip (3322) will pivot anvil(3360) toward and away from staple cartridge (3373). In addition,pivoting of a firing trigger (not shown) on handle assembly (3310) willdrive knife member (3380) distally through end effector (3340). Itshould therefore be understood that end effector (3340) and handleassembly (3310) are configured and operable substantially similar to endeffector (40) and handle assembly (320) described above. However, unlikeend effector (40), end effector (3340) of this example comprises a setof sensors (3390, 3392, 3394, 3396) and a marking (3394). These featureswill be described in greater detail below.

While end effector (3340) is described in the present example as beingcoupled with handle assembly (3310) of FIG. 74, it should be understoodthat the present teachings may also be readily applied in versions whereend effector (3340) is incorporated into a robotic surgical system. Forinstance, end effector (3340) may be readily incorporated into any ofthe various robotic surgical systems that are described in thereferences cited below; and cartridge (3200) may also be readily used insuch a combination. Other suitable ways in which end effector (3340) maybe incorporated into various kinds of robotic surgical systems, as wellas various ways in which cartridge (3200) may be used in such systems,will be apparent to those of ordinary skill in the art in view of theteachings herein.

Referring back to FIG. 73, cartridge (3200) of the present examplefurther includes an internal battery (not shown), a data port (3206), abattery recharge port (3208), a data transmitter (3210), a statusindicator window (3214), an expiration date listing (3216), anenvironmental condition indicator (3218), and an integral circuit board(3228). Circuit board (3228) includes (or is at least in communicationwith) all of the electronic circuit components that provide theoperability described herein. Various suitable components andarrangements that may be incorporated into circuit board (3228) will beapparent to those of ordinary skill in the art in view of the teachingsherein. Circuit board (3228) is powered by the internal battery. By wayof example only, the internal battery may comprise a button cell batteryand/or any other suitable kind of battery. In the present example, thebattery is rechargeable, though it should be understood that otherversions may include non-rechargeable batteries.

Data port (3206) is configured to enable wired communication between oneor more components that are on or otherwise coupled with circuit board(3228) and an external computing device (e.g., desktop computer, laptopcomputer, tablet computer, smartphone, robotic surgical system, etc.).Data port (3206) may thus be used to communicate data from cartridge(3200) to the external device. For instance, data port (3206) may beused to communicate any of the various kinds of information identifiedas being communicated below with respect to communication betweencartridge (3200) and instrument (3300). In addition or in thealternative, data port (3206) may be used to communicate data from theexternal device to cartridge (3200). For instance, data port (3206) maybe used to provide firmware updates, new information about buttresses(3201, 3202), and/or other information to cartridge (3200).

Battery recharge port (3208) is operable to couple with a wire toprovide electrical power that recharges the internal battery incartridge (3200). In some variations, battery recharge port (3208)comprises an inductive coil that is configured to provide wirelesselectrical recharging of the internal battery in cartridge (3200).Various suitable ways in which the internal battery in cartridge (3200)may be recharged will be apparent to those of ordinary skill in the artin view of the teachings herein. It should also be understood that someversions may lack recharging capability, such that the internal batteryin cartridge (3200) is non-rechargeable. Still other versions ofcartridge (3200) may lack an internal battery altogether. For instance,cartridge (3200) may include one or more photovoltaic cells that areconfigured to provide electrical power. As yet another merelyillustrative variation, cartridge (3200) may lack electrically poweredcomponents altogether.

Data transmitter (3210) is configured to provide wireless communicationbetween cartridge (3200) and instrument (3300) and/or other externaldevices (e.g., desktop computer, laptop computer, tablet computer,smartphone, robotic surgical system, etc.). While not shown, it shouldbe understood that instrument (3300) may include a data transmitter thatis configured to communicate wirelessly with data transmitter (3210) ofcartridge (3200). By way of example only, data transmitter (3210) may beconfigured to communicate wirelessly using the Bluetooth protocol, theZigbee protocol, and/or any other suitable wireless communicationprotocol as will be apparent to those of ordinary skill in the art inview of the teachings herein. In some instances, data transmitter (3210)only transmits data one way, to instrument (3300) and/or other externaldevices. In some other instances, data transmitter (3210) only receivesdata one way, from instrument (3300) and/or other external devices.Alternatively, data transmitter (3210) may provide bi-directionalcommunication with instrument (3300) and/or other external devices.Various suitable forms that transmitter (3210) may take will be apparentto those of ordinary skill in the art in view of the teachings herein.

By way of example only, the data communicated by transmitter (3210) mayinclude information relating to the kinds of buttresses (3201, 3202) onplatform (3222), information relating to the lot number and/orexpiration date associated with buttresses (3201, 3202) on platform,information relating to environmental conditions (e.g., temperature,humidity, etc.) that have been encountered by cartridge (3200), and/orany other suitable kind of information as will be apparent to those ofordinary skill in the art in view of the teachings herein. In someversions, cartridge (3200) is continuously powered by its internalbattery and continuously tracks data associated with environmentalconditions (e.g., temperature, humidity, etc.) that have beenencountered by cartridge (3200), then automatically transmits theinformation to instrument (3300) via transmitter (3210) in response toend effector (3340) coming into sufficient proximity to cartridge(3200). It should therefore be understood that cartridge (3200) and endeffector (3340) may include complementary features that enable cartridge(3200) to determine when end effector (3340) has come within sufficientproximity to cartridge (3200). Various suitable forms that such featuresmay take will be apparent to those of ordinary skill in the art in viewof the teachings herein. In some versions, transmitter (3210) sends theinformation to instrument (3300) In response to end effector (3340)being clamped on buttresses (3201, 3202) and platform (3222); and/orwhen end effector (3340) pulls buttresses (3201, 3202) away fromplatform (3222).

Status indicator window (3214) of the present example is configured toindicate status information relating to cartridge (3200) and/orbuttresses (3201, 3202). In some versions, status indicator window(3214) provides a fixed display, such as information printed on asticker or card, etc. In some other versions, status indicator window(3214) provides a dynamic display, such as information rendered throughan LCD screen, LED screen, and/or other form of display. By way ofexample only, status indicator window (3214) may indicate the kind ofbuttresses (3201, 3202) that are positioned on platform (3222), such asby reference to a type number or some other representation. The operatormay view this type number and thereby understand what kind of buttresses(3201, 3202) are positioned on platform (3222) (e.g., whether they havea certain kind of medicament, what material(s) they are formed of, whatkinds of surgical procedures they are intended for, etc.). While similarinformation may be rendered through display screen (3320) based on areading of indicia (3226) by sensors (3390, 3392), having suchinformation through status indicator window (3214) may enable theoperator to select an appropriate cartridge (3200) when presented withvarious cartridges (3200) to choose from. Moreover, the operator mayconfirm that the information presented through display screen (3320) isconsistent with the information presented through status indicatorwindow (3214). Other suitable information about buttresses (3201, 3202)that may be presented through status indicator window (3214) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

In addition to or as an alternative to presenting information aboutbuttresses (3201, 3202), status indicator window (3214) may presentinformation about the state of cartridge (3200). For instance, statusindicator window (3214) may indicate whether cartridge (3200) is readyfor use. It should also be understood that environmental conditionindicator (3218) may be readily integrated into status indicator window(3214). Environmental condition indicator (3218) will be described ingreater detail below. Other suitable kinds of information that may beprovided through status indicator window (3214) will be apparent tothose of ordinary skill in the art in view of the teachings herein.

It should be understood that some versions of buttresses (3201, 3202)may include one or more materials whose effectiveness, integrity, and/orother characteristics may degrade over a period of time. It maytherefore be desirable to indicate to the operator when that time hasbeen reached (or when a time has been reached that is some predeterminedduration before the degradation of buttress (3201, 3202) would beexpected). To that end, expiration date listing (3216) simply lists anexpiration date for buttresses (3201, 3202), directly on housing (3204)of cartridge (3200) to enable ready visibility. It should be understoodthat the operator may alternatively be informed of an expiration date inany other suitable fashion, such that cartridge (3200) may lackexpiration date listing (3216) in some versions.

Some versions of buttresses (3201, 3202) may include materials that aresensitive to environmental conditions, including but not limited totemperature and/or humidity. For instance, buttresses (3201, 3202) maytransition to an undesirable state if buttresses (3201, 3202) encountera temperature that is either above or below thresholds that provideupper and lower bounds, respectively, of a predetermined range.Likewise, buttresses (3201, 3202) may transition to an undesirable stateif buttresses (3201, 3202) encounter a humidity level that is eitherabove or below thresholds that provide upper and lower bounds,respectively, of a predetermined range. To that end, environmentalcondition indicator (3218) is configured to indicate environmentalconditions encountered by cartridge (3200). In some versions,environmental condition indicator (3218) is printed with environmentallysensitive ink whose properties change in response to environmentalconditions. For instance, environmental condition indicator (3218) maybe configured to present a checkmark when the humidity level is withinan appropriate range; and present an “X” when the humidity level isoutside the appropriate range. Similarly, environmental conditionindicator (3218) may be configured to present a checkmark when thetemperature level is within an appropriate range; and present an “X”when the temperature level is outside the appropriate range. It shouldalso be understood that environmental condition indicator (3218) mayinclude two or more regions. For instance, environmental conditionindicator (3218) may have one region that is responsive to humidity, oneregion that is responsive to temperature, etc. Other suitable conditionsthat environmental condition indicator (3218) may respond to will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Moreover, various suitable inks, features, and/or other components thatmay be used to form environmental condition indicator (3218) will beapparent to those of ordinary skill in the art in view of the teachingsherein. While environmental condition indicator (3218) of theabove-described example is passive, some versions of environmentalcondition indicator (3218) may be active (i.e., electrically powered).It should also be understood that environmental condition indicator(3218) may simply indicate present environmental conditions in realtime. In some versions, however, environmental condition indicator(3218) is configured to maintain an indication that one or moreenvironmental conditions has fallen outside of an acceptable range, evenif such environmental conditions return to the acceptable range. Forinstance, if cartridge (3200) is exposed to an unacceptably hightemperature or humidity level, the state of environmental conditionindicator (3218) may change to indicate that such level has exceeded anappropriate threshold; and environmental condition indicator (3218) maymaintain that changed state even after the temperature or humidity levelfalls back below the threshold. Various suitable ways in whichenvironmental condition indicator (3218) may maintain a changed statedespite a return in environmental conditions will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

Buttresses (3201, 3202) of the present example are substantiallyidentical to buttress assemblies (100, 110) described above, except thatbuttresses (3201, 3202) of the present example comprises indicia (3226)that are configured to be read by sensors (3390, 3392) (FIG. 75) on endeffector (3360). In the present example, indicia (3226) are printed onbuttresses (3201, 3202), though it should be understood that indicia(3226) may alternatively be otherwise applied to or otherwise integratedinto buttresses (3201, 3202). Indicia (3226) are configured to indicatethe type of buttresses (3201, 3202), such as whether buttresses (3201,3202) carry certain kinds of medicaments, such as whether buttresses(3201, 3202) have certain structural properties, the length ofbuttresses (3201, 3202), etc. Indicia (3226) may also convey informationsuch as the lot number, expiration date, and/or other data associatedwith buttresses (3201, 3202). Other suitable ways in which buttresses(3201, 3202) may vary, and how such variations may be conveyed throughindicia (3226), will be apparent to those of ordinary skill in the artin view of the teachings herein.

In the present example, sensors (3390, 3392) comprise optical sensorsand indicia (3226) comprise QR codes or some other form of opticalcoding, such that sensors (3390, 3392) are operable to read indicia(3226) by viewing indicia (3226). In some other versions, sensors (3390,3392) comprise RFID readers and indicia (3226) comprise RFID chips, suchthat sensors (3390, 3392) read indicia (3226) through RFID sensing.Other suitable forms that sensors (3390, 3392) and indicia (3226) cantake will be apparent to those of ordinary skill in the art in view ofthe teachings herein. Regardless of the form of indicia (3226) andsensors (3390, 3392), instrument (3300) may process the data fromindicia (3226) in various ways. For instance, if instrument (3300)determines that the operator is attempting to load end effector (3340)with buttresses (3201, 3202) that are not configured for use with thatparticular end effector (3340), a control logic in instrument (3300) maynotify the operator (e.g., via display screen (3320)) and, in someversions, prevent usage of instrument (3300). In addition or in thealternative, instrument (3300) may vary the force and/or speed withwhich knife member (3380) is driven based on the detected kind ofbuttresses (3201, 3202) loaded on end effector (3340). In addition or inthe alternative, instrument (3300) may vary the closure force or closuregap provided through end effector (3340) based on the detected kind ofbuttresses (3201, 3202) loaded on end effector (3340). Other variousways in which instrument (3300) may respond based on the detected kindof buttresses (3201, 3202) loaded on end effector (3340) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

In the present example, buttress (3202) has a length that corresponds tothe length of underside (3365) of anvil (3360); and buttress (3201) hasa length that corresponds to the length of deck (3373) of staplecartridge (3370). It may therefore be desirable to ensure that theoperator has located end effector (3340) at the appropriate longitudinalposition in relation to platform (3222) when end effector (3340) isclosed upon buttresses (3201, 3202), to thereby ensure that buttresses(3201, 3202) appropriately span the full lengths of deck (3373) andunderside (3365). To that end, platform (3222) of the present examplefurther comprises an alignment marking (3212). Marking (3212) extendsperpendicularly relative to the longitudinal axis of platform (3222).Marking (3212) is configured to correspond with marking (3294) of anvil(3360), as shown in FIG. 77. Marking (3294) of anvil (3360) extendsperpendicularly relative to the longitudinal axis of anvil (3360).Markings (3212, 3294) are positioned such that markings (3212, 3294)will align with each other when the operator has located end effector(3340) at the appropriate longitudinal position in relation to platform(3222). In the event that markings (3212, 3294) are initiallymis-aligned, the operator may simply move end effector (3340) and/orcartridge (3200) until markings (3212, 3294) are aligned. The operatormay then fully close end effector (3340) to pick up buttresses (3201,3202) from platform (3222).

As best seen in FIGS. 79A-79C, platform (3222) of the present examplealso includes an internal magnet (3220). While magnet (3220) is inplatform (3222) in the present example, it should be understood thatmagnet (3220) may alternatively be located in other locations (e.g., inone or both of prongs (3224)). Magnet (3220) is configured to interactwith hall effect sensors (3394, 3396), which are integrated into staplecartridge (3370) and anvil (3340). In particular, as shown in FIG. 79B,hall effect sensors (3394, 3396) sense the magnetic field of magnet(3220) when end effector (3340) is closed upon buttresses (3201, 3202)and platform (3222). A control circuit that is in communication withsensors (3394, 3396) may be tuned to determine when the signal fromsensors (3394, 3396) indicates that end effector (3340) has closed uponbuttresses (3201, 3202) and platform (3222) with a sufficient force. Ofcourse, there are other ways in which such a determination may be made.For instance, a position sensor in end effector (3340) may sense theclosure angle of anvil (3360) relative to staple cartridge (3370) and/ora force sensor in end effector (3340) may sense the closure pressurebeing applied by anvil (3360) and/or cartridge (3370). As another merelyillustrative example, platform (3222) may include a strain gauge orforce sensor, etc. Other suitable components and techniques that may beused to sense whether end effector (3340) has closed upon buttresses(3201, 3202) and platform (3222) with a sufficient force will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Regardless of the features that are used to determine whether endeffector (3340) has closed upon buttresses (3201, 3202) and platform(3222) with a sufficient force, the associated data may be used innumerous ways. For instance, in versions where status indicator window(3214) is dynamic, status indicator window (3214) may be used to providea visual indication to the operator to indicate that end effector (3340)has closed upon buttresses (3201, 3202) and platform (3222) with asufficient force. As another merely illustrative example, cartridge(3200) may include a feature that is operable to emit an audible tone toindicate to the operator to indicate that end effector (3340) has closedupon buttresses (3201, 3202) and platform (3222) with a sufficientforce. Similar audio and/or visual feedback may be provided throughhandle assembly (3310), in addition to or in lieu of being providedthrough cartridge (3200). For instance, display screen (3320) may beused to provide a visual indication to the operator to indicate that endeffector (3340) has closed upon buttresses (3201, 3202) and platform(3222) with a sufficient force.

In some versions, it may be desirable to provide clamping of endeffector (3340) on buttresses (3201, 3202) for at least a certainduration in order to ensure proper adhesion of buttresses (3201, 3202)to end effector (3340). To that end, once one or more features detectthat end effector (3340) has closed upon buttresses (3201, 3202) andplatform (3222) with a sufficient force, a control logic may begin atimer to clock the duration of that force. The control logic may thentrigger an audible feedback feature and/or visual feedback feature oncethe sufficient force has been applied for the predetermined duration. Insome such versions, a visual feedback feature may provide the operatorwith a real time count-up or count-down, enabling the operator to viewhow much more time the operator will need to hold end effector (3340) ina closed state. FIG. 78 shows one merely illustrative example of howthis may be done through display screen (3320). In this example, thecontrol logic begins illuminating discrete visual elements in a lineararray when the sufficient force is detected; and further illuminates thevisual elements in a progression along the array during the span of thepredetermined duration. When all of the visual elements in the array areilluminated, this provides visual feedback to the operator indicatingthat the predetermined duration has passed. The operator may then openend effector (3340) and pull end effector (3340) away from cartridge(3200). Again, the full illumination of the last visual element in thearray may also be accompanied by an audible tone and/or some other formof feedback. Other suitable ways in which an operator may receivefeedback indicating whether end effector (3340) has sufficiently clampedon buttresses (3201, 3202) will be apparent to those of ordinary skillin the art in view of the teachings herein.

It should also be understood that different kinds of buttresses (3201,3202) may warrant different closure forces from end effector (3340)and/or different closure durations in order to be adequately secured toend effector (3340). In such instances, a control logic (e.g., in handleassembly (3310)) may determine which closure force and/or duration tosense based on the kind of buttress (3201, 3202) identified by sensors(3390, 3392) from indicia (3226).

Display screen (3320) may provide various kinds of information inaddition to or in lieu of the information noted above. For instance,display screen (3320) may indicate whether buttresses (3201, 3202) areproperly aligned in relation to end effector (3340), the initiation of astart-up routine in handle assembly (3310), the identity/type ofbuttresses (3201, 3202), the kind(s) of medical procedure that theparticular buttresses (3201, 3202) are best suited for, the successfulloading of buttresses (3201, 3202) on end effector (3340), warnings andprecautions associated with the particular kind of buttresses (3201,3202), the thickness of buttresses (3201, 3202), the thickness of tissuecaptured between anvil (3360) and staple cartridge (3370), thepresence/type of medicament on buttresses (3201, 3202), the compressiontime required for buttresses (3201, 3202) to be properly adhered to endeffector (3340), and/or the duration for which the operator may expectbuttresses (3201, 3202) to remain properly adhered to end effector(3340). Other kinds of information that may be indicated through displayscreen (3320) will be apparent to those of ordinary skill in the art inview of the teachings herein. It also should be understood that suchinformation may come from various sources, including but not limited tocartridge (3200) (e.g., as communicated via transmitter (3210)) buttress(3201, 3202) (e.g., via indicia (3226) and sensors (3390, 3392)); anvil(3360); and/or cartridge (3370). Other suitable sources of informationthat may be indicated through display screen (3320) will be apparent tothose of ordinary skill in the art in view of the teachings herein.

In an exemplary use, the operator views indicator window (3214),expiration date listing (3216), and environmental condition indicator(3218) to confirm that cartridge (3200) is appropriate for the presentsurgical procedure and is ready for use. The operator then positions endeffector positions end effector (3340) between prongs (3224) of housing(3204) as shown in FIG. 77. The operator then closes end effector (3340)on buttresses (3201, 3202) and platform (3222) as shown in FIG. 79B.This causes sensors (3390, 3392) to read indicia (3226), resulting invisual feedback through display screen (3320) indicating informationassociated with buttresses (3201, 3202) as noted above. As the operatorclamps down on buttresses (3201, 3202) and platform (3222) with endeffector (3340), hall effect sensors (3394, 3396) sense the magneticfield of magnet (3220) in platform (3222). This results in signals thatdrive visual feedback through display screen (3320) as shown in FIG. 78.Once the operator confirms that end effector (3340) has been clampedwith sufficient force for a sufficient duration, the operator opens endeffector (3340). Buttresses (3201, 3202) will be adhered to underside(3365) of anvil (3360) and deck (3373) of cartridge (3370) via adhesivelayers of buttresses (3201, 3202), such that the opened end effector(3340) will remove buttresses (3201, 3202) from platform (3222) as shownin FIG. 79C. The operator may then use end effector (3340) on tissue inaccordance with the teachings above in relation to FIGS. 5A-6. Othersuitable ways in which cartridge (3200) and instrument (3300) may beused will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

XXIII. EXEMPLARY PROTECTION AND CONTAINMENT FEATURES FOR FLOWABLEADHESIVE

In some instances, it may be desirable to use an adhesive layer (104,114) that comprises a flowable adhesive material (e.g., an adhesive gel,etc.). Such a flowable adhesive material may comprises PVP blends,polymer blends, PCL/PGA blends, and/or various other kinds of materials.By way of example only, providing a flowable adhesive layer (104, 114)may further promote adhesion of buttress assemblies (100, 110) due tothe adhesive material flowing into staple forming pockets (64) and/orother nooks and crannies in end effector (440). However, providingflowability in adhesive layers (104, 114) may also present difficultieswith respect to containing adhesive layers (104, 114) on buttress bodies(102, 112), as the flowable adhesive layers (104, 114) may have atendency to migrate off of buttress bodies (102, 112). This may beparticularly so when the flowable adhesive layers (104, 114) are exposedto a temperature that exceeds the melting temperature of the flowableadhesive layers (104, 114). It may therefore be desirable to provide afeature that contains a flowable adhesive layer (104, 114) in place on abuttress body (102, 112), up until the point of a procedure where theoperator wishes to secure buttress assemblies (100, 110) to end effector(440).

Several merely illustrative examples of features that may be used tocontain a flowable adhesive layer (104, 114) in place on a buttress body(102, 112) will be described in greater detail below. Those of ordinaryskill in the art will recognize that a feature that contains a flowableadhesive layer (104, 114) in place on a buttress body (102, 112) mayalso provide protection to adhesive layer (104, 114), such as protectionagainst moisture, debris, etc. It should therefore be understood thatthe features described below may be used to protect adhesive layer (104,114) against moisture, debris, etc. Thus, while the following examplesare provided in the context of an adhesive layer (104, 114) that isflowable, the features described below may also be used in the contextof an adhesive layer that is non-flowable. It should also be understoodthat the features described below may be used to contain and/or protectsubstances other than adhesive layers (104, 114), including but notlimited to medicaments, in addition to or in lieu of containing and/orprotecting adhesive layers (104, 114).

While the following examples are provided in the context of adhesivematerials that are flowable, it should be understood that this does notnecessarily mean that the adhesive materials would necessarily beflowable under all conditions or even at room temperature. For instance,some adhesive materials may have a melting point that is just slightlyhigher than room temperature; but that is still low enough to beexceeded during many standard product shipping conditions. Thus, theadhesive containment features described below may prevent the adhesivematerial from migrating along the underlying buttress body (102, 112)when the melting temperature is exceeded (e.g., during shipment); yetthe adhesive material may be re-solidified by the time the adhesivecontainment feature is removed to reveal the adhesive material.

A. Exemplary Buttress Assembly Loading Cartridge with AdhesiveContainment Sheet

FIGS. 80-81 show an exemplary cartridge (4200) that may be used to loada pair of buttress assemblies (4230) on an end effector (440). Cartridge(4200) of this example comprises a housing (4210) that defines a “U”shape including a central recess (4212). Central recess (4212) has alength and width that are sized to accommodate an anvil (60) and a lowerjaw (50) loaded with a staple cartridge (70). A platform (4220) ispositioned within recess (4212) and supports buttress assembly (4230).In the present example, only one buttress assembly (4230) is shown on anupper surface (4222) of platform (4220). However, it should beunderstood that another identical buttress assembly (4230) may bepositioned on the lower surface of platform (4220) in a similar fashion.A set of resilient retainers (4214) assist in removably securingbuttress assembly (4230) to platform (4220) in this example. By way ofexample only, retainers (4214) and/or other aspects of cartridge (4200)may be constructed and operable in accordance with at least some of theteachings of U.S. Provisional Patent App. No. 62/209,041, entitled“Method and Apparatus for Applying a Buttress to End Effector of aSurgical Stapler,” filed Aug. 24, 42015, the disclosure of which isincorporated by reference herein. Alternatively, retainers (4214) may beomitted.

As best seen in FIGS. 81-82, an adhesive containment sheet (4240) islaid over a buttress assembly (4230), which comprises buttress body(4260) and an adhesive layer (4270). Adhesive containment sheet (4240)may comprise a thin film, foil, or other construction formed of anysuitable material or combination of materials as will be apparent tothose of ordinary skill in the art in view of the teachings herein.Adhesive containment sheet (4240) is configured such that the materialforming adhesive layer (4270) will not pass through containment sheet(4240) or adhere to containment sheet (4240). Various suitable materialsthat may be used to form containment sheet (4240) will be apparent tothose of ordinary skill in the art in view of the teachings herein.

Buttress body (4260) may be constructed and operable just like buttressbody (102, 112). By way of example only, buttress body (4260) may beconstructed and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, the disclosure of which is incorporated by reference herein.Adhesive layer (4270) of the present example comprises a flowableadhesive material. By way of example only, adhesive layer (4270) may beconstructed and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, the disclosure of which is incorporated by reference herein.

Buttress body (4260) is laid directly on upper surface (4220) ofplatform (4220), adhesive layer (4270) is laid directly on buttress body(4260), and adhesive containment sheet (4240) is laid directly onadhesive layer (4270). Adhesive containment sheet (4240) has a length(L₁) and a width (W₁). In the present example, buttress body (4260) andadhesive layer (4270) are coextensive in length and width, such thatbuttress body (4260) and adhesive layer (4270) both have a length (L₂)and a width (W₂). The length (L₁) of adhesive containment sheet (4240)is greater than the length (L₂) of buttress body (4260) and adhesivelayer (4270). Similarly, the width (W₁) of adhesive containment sheet(4240) is greater than the width (W₂) of buttress body (4260) andadhesive layer (4270). Adhesive containment sheet (4240) is thus sizedto completely cover both buttress body (4260) and adhesive layer (4270).In particular, the outer edges (4244) of adhesive containment sheet(4240) are configured to be adhered directly to upper surface (4222) ofplatform (4220), such that adhesive containment sheet (4240) andplatform (4220) cooperate to fully encompass buttress body (4260) andadhesive layer (4270). In some versions, outer edges (4244) of adhesivecontainment sheet (4240) include an adhesive material that enables outeredges (4244) to be removably adhered to upper surface (4222). Inaddition or in the alternative, retainers (4214) may assist in removablyretaining adhesive containment sheet (4240) against upper surface(4222). Other suitable ways in which adhesive containment sheet (4240)may be removably secured to upper surface (4222) will be apparent tothose of ordinary skill in the art in view of the teachings herein. Itshould be understood that, while adhesive containment sheet (4240) issecured to upper surface (4222), adhesive containment sheet (4240) willcontain adhesive layer (4270) by maintaining the position of adhesivelayer (4270) on buttress body (4260).

In an exemplary use of cartridge (4200), an operator may first peeladhesive containment sheet (4240) away from platform (4220), adhesivelayer (4270), and buttress body (4260). To assist in such peeling awayof adhesive containment sheet (4240), adhesive containment sheet (4240)includes an integral pull-tab (4242). The operator may thus grasp pulltub (4242) and thereby peel adhesive containment sheet (4240) away fromplatform (4220), adhesive layer (4270), and buttress body (4260). Thiswill result in adhesive layer (4270) being exposed. The operator maythen position end effector (440) in recess (4212), then actuate anvil(60) to close anvil (60) against platform (4220) as end effector (440)reaches a closed configuration. Lower jaw (50) and staple cartridge (70)will be positioned on the underside of platform (4220), providing anopposing force such that anvil (60) may be clamped against adhesivelayer (4270). As anvil (60) clamps against adhesive layer (4270), theadhesive material forming adhesive layer (4270) may flow into stapleforming pockets (64) and/or other nooks and crannies in underside (65)of anvil (60). The material forming adhesive layer (4270) may thusadhere buttress body (4260) to underside (65). When the operator pivotsanvil (60) away from platform (4220) to return end effector (440) to anopen configuration, anvil (60) will pull buttress body (4260) away fromplatform (4220), and buttress body (4260) will remain adhered tounderside (65) by adhesive layer (4270). End effector (440) may then beused as described above with reference to FIGS. 5A-5C.

As noted above, another combination of buttress assembly (4230) andadhesive containment sheet (4240) may be provided on the underside ofplatform (4220), in addition to or as an alternative to the combinationof buttress assembly (4230) and adhesive containment sheet (4240) beingprovided on upper surface (4222) of platform. An operator may thusemploy the same process as described above to adhere a buttress assembly(4230) to deck (73) of staple cartridge (70), in addition to or as analternative to adhering a buttress assembly (4230) to underside (65) ofanvil (60).

B. Exemplary Cartridge Packaging with Integral Adhesive ContainmentSheet

In some instances, it may be desirable to provide cartridge (4200) in asterile package for transport and storage, such that the sterile packagemay protect cartridge (4200) from contamination up until an operator isready to use cartridge (4200) to apply a buttress assembly to an endeffector (440). In versions where cartridge supports a buttress assemblyhaving a flowable adhesive, it may also be desirable to incorporate anadhesive containment feature in such a sterile package. To that end,FIGS. 83A-83B show an exemplary sterile package (4300) that includes anintegral adhesive containment strip (4340). Sterile package (4300) ofthis example includes a container (4310) that is sized to contain theentirety of cartridge (4200). Container (4310) includes an upper lip(4312). A protective film (4314) is adhered to upper lip (4312) therebyhermetically sealing cartridge (4200) in container (4310).

Adhesive containment strip (4340) includes a tab (4342) that is fixedlysecured to the underside of protective film (4314). When protective film(4314) is secured to lip (4312) as shown in FIG. 83A, adhesivecontainment strip (4340) is positioned over adhesive layer (4270) andthus contains adhesive layer (4270) on buttress body (4260). Adhesivecontainment strip (4340) thus operates just like adhesive containmentsheet (4240) when package (4300) is in the sealed state shown in FIG.83A. However, when protective film (4314) is peeled away from lip (4312)as shown in FIG. 83B, protective film (4314) peels adhesive containmentstrip (4340) away from adhesive layer (4270) and buttress body (4260).Cartridge (4200) may then be removed from container (4310) and an endeffector (440) may be clamped onto platform (4220) as described above toadhere buttress assembly (4230) to underside (65) of anvil (60) viaadhesive layer (4270).

C. Exemplary Buttress Assembly with Adhesive Containment Sheet Securedto Buttress Body

FIGS. 84-85 show another exemplary buttress assembly (4350). Buttressassembly (4350) of this example comprises an adhesive containment strip(4360) that is adhered to an upper surface (4372) of a buttress body(4370). Buttress body (4370) may be configured and operable just likeany other buttress body described herein or described in any of thevarious references cited herein. The outer edges (4364) of adhesivecontainment strip (4360) are adhered to the outer edges of upper surface(4372). A flowable adhesive material (4380) is positioned on uppersurface (4372), such that adhesive material (4380) is captured betweenadhesive containment strip (4360) and buttress body (4370). Adhesivecontainment strip (4360) thus contains adhesive material (4380) onbuttress body (4370). Adhesive containment strip (4360) includes a tab(4362) that an operator may grasp to peel adhesive containment strip(4360) away from buttress body (4370) to thereby reveal adhesivematerial (4380). The operator may then secure buttress body (4370) to anend effector (440) via adhesive material (4380) by clamping anvil (60)or staple cartridge (70) against the revealed adhesive material (4380).In some versions, buttress assembly (4350) is incorporated intocartridge (4200) as described above. Other suitable ways in whichbuttress assembly (4350) may be configured and used will be apparent tothose of ordinary skill in the art in view of the teachings herein.

D. Exemplary Buttress Adhesive Loading Cartridge with AdhesiveContainment Sheet

In some instances, it may be desirable to apply adhesive layer (104,114) to end effector (440) first, then apply buttress body (102, 112) toend effector (440) via adhesive layer (104, 114). This may be desirablein instances where it is beneficial to store and contain buttress body(102, 112) separately from adhesive layer (104, 114). FIGS. 86A-87 showan exemplary adhesive cartridge (4400) that may be used to store andcontain an adhesive material (4440) by itself (i.e., without adhesivematerial (4440) being predisposed on a buttress body). Cartridge (4400)of this example comprises a housing (4410) that defines a “U” shapeincluding a central recess (4412). Central recess (4412) has a lengthand width that are sized to accommodate an anvil (60) and a lower jaw(50) loaded with a staple cartridge (70). A platform (4420) ispositioned within recess (4412) and supports two layers of adhesivematerial (4440), with one layer of adhesive material (4440) on an upperside of platform (4420) and another layer of adhesive material (4440) ona lower side of platform (4420). Adhesive material (4440) may beconstructed and operable in accordance with the teachings herein and/orin accordance with the teachings of any of the references cited herein.

As best seen in FIG. 87, housing (4410) includes ledges (4414) incentral recess (4412), adjacent to platform (4420). Ledges (4414) thusprovide a stepped transition between platform (4420) and the remainderof platform (4420). As also seen in FIG. 87, adhesive material (4440) ispositioned between adjacent regions of ledges (4414), such that ledges(4414) contain adhesive material (4440) to at least some degree. A pairof adhesive containment sheets (4430) are positioned to contain adhesivematerial (4440) between adjacent regions of ledges (4414). Inparticular, each adhesive containment sheet covers a corresponding layerof adhesive material (4440). In some versions, outer edges of adhesivecontainment sheet (4430) include an adhesive material that enables outeredges of adhesive containment sheet (4430) to be removably adhered toplatform (4420). Adhesive containment sheet (4430) of the presentexample comprises a pull-away tab (4432) that is operable to peeladhesive containment sheet (4430) off of ledges (4414), to therebyreveal adhesive material (4440).

In an exemplary use, an operator may grasp tab (4432) and thereby peeladhesive containment sheet (4430) off of ledges (4414), therebyrevealing adhesive material (4440). In some instances, the operator maypeel just one adhesive containment sheet (4430) off of ledges (4414)(i.e., just the upper adhesive containment sheet (4430) or just thelower adhesive containment sheet (4430)). This may be done if theoperator only wishes to apply adhesive material (4440) to anvil (60) orcartridge (70) but not both. Alternatively, the operator may peel bothadhesive containment sheets (4430) off of ledges (4414). This may enablethe operator to apply adhesive material (4440) to anvil (60) andcartridge (70). In either case, the operator may apply adhesive material(4440) to anvil (60) and/or cartridge (70) by positioning end effector(440) in central recess (4412), then clamping down on the exposedadhesive material (4440) by actuating end effector (440) to the closedconfiguration. In the event that one of the containment sheets (4430) isleft on ledges (4414) when the operator clamps end effector (440) oncartridge (4400), that containment sheet (4430) and the underlyingadhesive material (4440) may be left intact. When the operator returnsend effector (440) to the open configuration, the adhesive material(4440) may be positioned on underside (65) of anvil (60) and/or deck(73) of cartridge (70).

With adhesive material (4440) applied to underside (65) of anvil (60)and/or deck (73) of cartridge (70), the operator may then apply abuttress body (e.g., similar to any of the buttress bodies referred toherein) to the applied adhesive material (4440). By way of example only,a variation of cartridge (4200) may be configured to carry one or morebuttress bodies without also including an adhesive layer or protectivesheet. The operator may thus clamp end effector (440) down on thebuttress body, and the adhesive material (4440) applied to underside(65) of anvil (60) or deck (73) of cartridge (70) will adhere to thebuttress body. Thus, when the operator returns end effector (440) to theopen configuration, the applied adhesive material (4440) will havepicked up the buttress body and will have thereby adhered the buttressbody to underside (65) of anvil (60) or deck (73) of cartridge (70).Other suitable ways in which a buttress body may be applied to an endeffector (440) that is preloaded with an adhesive material (4440) willbe apparent to those of ordinary skill in the art in view of theteachings herein.

XXIV. EXEMPLARY MULTILAYER BUTTRESS BODY

In some instances, it may be desirable to have a multilayer buttressbody instead of one uniform buttress body (102, 112) attached toadhesive layer (104, 114). A buttress body with multiple layers mayprovide added benefits stemming from the diverse material properties ofeach layer, either while attached to end effector (70) via adhesivelayer (104, 1140) or while attached to tissue (T₁, T₂) via staples (90).For example, one layer may be utilized to provide the benefit of tissuereinforcement while another layer may be utilized to further promotehemostasis or a combination thereof. Additionally or alternatively,placement of multiple layers relative to each other may provideadditional benefits. For instance, a first layer may be placed betweenadhesive layer (104, 114) and a second layer in order to allow adhesivelayer (104, 114) to better adhere to underside (65) of anvil (60) and/ordeck (73) of staple cartridge (70). Various examples of multilayerbuttress bodies will be described in greater detail below. It should beunderstood that the following examples may be used in place of buttressassemblies (100, 110) described above.

A. Multilayer Buttress Body with Continuous Film Layer

FIG. 91 shows a multilayer buttress assembly (5200) including amultilayer buttress body (5202) and an adhesive layer (5204). Multilayerbuttress assembly (5200) may be used with end effector (40) in place ofeither or both buttress assemblies (100, 110) as mentioned above.Therefore, adhesive layer (5204) may be substantially similar toadhesive layers (104, 114) mentioned above. As such, multilayer buttressassembly (5200) may be adhered to underside (65) of anvil (60) and/ordeck (73) of staple cartridge (70). The material forming adhesive layer(5204) may provide proper positioning of multilayer buttress body (5202)before and during actuation of end effector (40); then allow multilayerbuttress body (5202) to separate from end effector (40) after endeffector (40) has been actuated, without causing damage to multilayerbuttress body (5202) that is substantial enough to compromise the propersubsequent functioning of multilayer buttress body (5202). By way ofexample only, adhesive layer (5204) may be constructed and operable inaccordance with at least some of the teachings of U.S. patentapplication Ser. No. 14/667,842, entitled “Method of Applying a Buttressto a Surgical Stapler,” filed Mar. 25, 2015, the disclosure of which isincorporated by reference herein.

FIGS. 90-91 show multilayer buttress body (5202) including a mesh layer(5206) and a film layer (5208). Film layer (5208) may comprise anysuitable bioabsorbable materials, including but not limited to PDS(polydioxanone), polyglactin 910, or polyglecaprone 25. Various othersuitable materials that may be used will be apparent to those ofordinary skill in the art in view of the teachings herein. Film layer(5208) is integrally connected to mesh layer (5206) and lies on top ofmesh layer (5206). Film layer (5208) may be integrally connected to meshlayer (5206) through a heated press, combining pressure and heat. Itshould be understood film layer (5208) is a continuous film with minimalporosity in the present example. In other words, film layer (5208)prevents fluid from traveling across its boundaries.

As shown in FIG. 90, mesh layer (5206) is a two dimensional planarconstruct allowing minimal stretching. Mesh layer (5206) may be made ofplanar fabrics (5207) that are combined in a matrix. The matrix formedof planar fabrics (5207) may be knitted or woven together in a pattern,or in a random association. FIG. 90 shows matrix formed of planarfabrics (5207) knitted or woven in a square texture pattern. However,any number of suitable texture patterns may be used as would be apparentto a person having ordinary skill in the art in view of the teachingsherein.

While FIG. 90 shows mesh layer (5206) in a two dimensional planarconstruct, it is envisioned mesh layer (5206) may form a threedimensional mesh layer construct in some other versions. For instance, athree dimensional version of mesh layer (5206) may be made out ofknitted spacer fabrics, Rachel knitted spacer fabrics, uncut velvet,terry cloth, or any other suitable material as will be apparent to aperson having ordinary skill in the art in view of the teachings herein.A three dimensional version of mesh layer (5206) may allow for minimalextensibility in one direction and spring-like extensibility in aperpendicular direction. The direction with minimal extensibility couldbe utilized for reinforcement of recently severed tissue (T₁, T₂); whilethe spring-like extensibility could be utilized in order to compensatefor tissue deformation after end effector (40) severs and staples tissueas described above.

As shown in FIG. 91, film layer (5208) is adhered under adhesive layer(5204). Due to film layer (5208) being interposed between mesh layer(5206) and adhesive layer (5204) in combination with the continuousnature and minimal porosity of film layer (5208), film layer (5208) mayact as a sealed barrier between mesh layer (5206) and adhesive layer(5204). In other words, fluids are prevented from passing through filmlayer (5208) in this example. Therefore, if adhesive layer (5204) becameviscous, film layer (5208) may prevent adhesive layer (5204) frompenetrating into mesh layer (5206). This may prevent the viscous natureor adhesive layer (5204) from spreading too thin, which may compromisethe adhesion between multilayer buttress assembly (5200) and endeffector (40). In addition, moisture (e.g., bodily fluid, saline, etc.)obtained through mesh layer (5206) may not penetrate onto adhesive layer(5204). This may allow adhesive layer (5204) to properly adhere tounderside (65) of anvil (60) or deck (73) of staple cartridge (70) forlonger periods of time in a moist environment, such as a surgical site.

It should be understood that because film layer (5208) acts as a barrierbetween mesh layer (5206) and adhesive layer (5204), mesh layer (5206)will be the portion of multilayer buttress body (5202) in contact withtissue (T₁, T₂) when end effector (40) clamps, severs, and staplestissue (T₁, T₂) as described above when utilizing multilayer buttressassembly (5200). Therefore, film layer (5208) will be closer tounderside (65) of anvil (60) and/or deck (73) of staple cartridge (70).If multilayer buttress assembly (5200) is used on both underside (65) ofanvil (60) and deck (73) of staple cartridge (70), a pair of film layers(5208) would be surrounding both tissue (T₁, T₂) and mesh layers (5206).This geometry surrounding tissue (T₁, T₂) may help prevent tissue (T₁,T₂) from forming an adhesion at the site of stapling and severing.

Film layer (5208) may be made out of a material that is conformable. Inother words, once film layer (5208) is punctured by staples (90), filmlayer (5208) conforms around staple (90) and forms a seal around theportion of staple legs (94) penetrating film layer (5208). This mayallow for film layer (5208) to still act as a barrier after multilayerbuttress (5200) is detached from end effector (40) and attached totissue (T₁, T₂) via staples (90) as shown in FIG. 6. This sealing effectmay enhance hemostasis. Also, due to the continuous nature and minimalporosity of film layer (5208), film layer (5208) may also spreadpressure from driven staples (90) on a more uniform area of compressionon tissue (T₁, T₂), also potentially enhancing hemostasis.

If multilayer buttress assembly (5200) is located on deck (73) of staplecartridge (70), film layer (5208) may also act as a barrier betweentissue (T₁, T₂) and deck (73) of staple cartridge (70). As describedabove, deck (73) houses staples (90), which are driven by staple driver(75). Tissue (T₁, T₂) may exert fluids or flowing tissue into deck (73)when compressed by anvil (60) pivoting towards lower jaw (50). Thesefluids or flowing tissue may impart of force on individual staples (90)located within deck (73), creating a misalignment between staple crown(92) and staple driver (75). This misalignment may lead to a higherprobability of staple legs (94) hitting staple forming pockets (64) inan unintended orientation, possibly leading to an inadequate stapleformation. However, the sealed barrier created by film layer (5208) mayprevent tissue (T₁, T₂) exerting fluid or flowing tissue into deck (73),thereby increasing the probability of a proper staple (90) formingagainst staple forming pocket (64).

Additionally, when end effector (40) clamps, severs, and staples tissue(T₁, T₂), staples (90) will travel through planar fabrics (5207) of meshlayer (5206), potentially confining staple legs (94) within the matrixdefined by mesh layer (5206). This confinement may allow mesh layer(5206) to help interlock individual staples (90) in such a way thatstaples (90) act as a group. The confinement of staples (90) may alsoallow mesh layer (5206) to absorb and distribute loads provided bydriving staples (90) that would otherwise be directly transferred totissue (T₁, T₂), which may help prevent tissue failure due tooverstress.

In some exemplary variations of buttress assembly (5200), another filmlayer may be positioned under mesh layer (5206). By way of example only,this additional film layer may be configured and operable just like filmlayer (5208) described above. Mesh layer (5206) may thus be interposedbetween two film layers (5208). By way of further example only, theadditional film layer may be added for increased reinforcement strength,increased stiffness, reduced overall porosity, reduced friction orincreased adhesion to adhesive layer.

B. Multilayer Buttress Body with Punctured Film Layer

FIG. 92 shows a multilayer buttress assembly (5300) including amultilayer buttress body (5302) and an adhesive layer (5304). Multilayerbuttress assembly (5300) may be used with end effector (40) in place ofeither or all buttress assemblies (100, 110, 5200) mentioned above.Therefore, adhesive layer (5304) may be substantially similar toadhesive layers (104, 114, 5204) mentioned above. As such, multilayerbuttress assembly (5300) may be adhered to underside (65) of anvil (60)and/or deck (73) of staple cartridge (70). The material forming adhesivelayer (5304) may provide proper positioning of multilayer buttress body(5302) before and during actuation of end effector (40); then allowmultilayer buttress body (5302) to separate from end effector (40) afterend effector (40) has been actuated, without causing damage tomultilayer buttress body (5302) that is substantial enough to compromisethe proper subsequent functioning of multilayer buttress body (5302). Byway of example only, adhesive layer (5304) may be constructed andoperable in accordance with at least some of the teachings of U.S.patent application Ser. No. 14/667,842, entitled “Method of Applying aButtress to a Surgical Stapler,” filed Mar. 25, 2015, the disclosure ofwhich is incorporated by reference herein.

FIGS. 92-93 show multilayer buttress body (5302) including a mesh layer(5306) and a film layer (5308) interposed between mesh layer (5306) andadhesive layer (5304). Mesh layer (5306) further includes a bottom meshportion (5324), a top mesh portion (5322), and a plurality of open loops(5326) extending from top mesh portion (5322). As will be described infurther detail below, loops (5326) may extend within and/or through filmlayer (5308) in order to promote attachment between adhesive layer(5304) and mesh layer (5306). Therefore, unlike multilayer buttressassembly (5200) described above, mesh layer (5306) could be designed tohave some fluid communication with adhesive layer (5304). Loops (5326)may be formed on top mesh portion (5322) through various methods, suchas needle tufting, sewing through top mesh portion (5322) with a thread,or any other suitable methods as will be apparent to a person havingordinary skill in the art in view of the teachings herein. It should beunderstood that loops (5326) are merely optional in order to promoteattachment between adhesive layer (5304) and mesh layer (5306). Forinstance, instead of loops (5326), top mesh portion (5322) may havestrings extending from top mesh portion (5322) to promote attachmentbetween adhesive layer (5304) and mesh layer (5306).

Mesh layer (5306) forms a three dimensional mesh layer construct. Threedimensional mesh layer (5306) may be made out of knitted spacer fabrics,Rachel knitted spacer fabrics, uncut velvet, terry cloth, or any othersuitable material as will be apparent to a person having ordinary skillin the art in view of the teachings herein. Fibers forming mesh layer(5306) may have surface properties of a multifilament, a monofilament,or any extrudable shapes, any of which could be surface activated foradhesion.

As can be seen in FIGS. 94A-94B, three dimensional mesh layer (5306) ofthe present example has partial elasticity that provides minimalextensibility in one direction (along the plane defined by mesh layer(5306)) and spring-like extensibility in a perpendicular direction (alsoalong the plane defined by mesh layer (5306)). The direction withminimal extensibility could be utilized for reinforcement of recentlysevered tissue (T₁, T₂) while the spring-like extensibility could beutilized in order to compensate for tissue deformation after endeffector (40) severs and staples tissue as described above. In thepresent example, mesh layer (5306) is provided in a rectangular shape,with the longer length extending in a longitudinal direction along acorresponding length of end effector (40); and with the shorter widthextending in a lateral direction along a corresponding with of endeffector (40). Also in the present example, mesh layer (5306) has theresilient extensibility in the longitudinal direction and the minimalextensibility in the lateral direction. It should therefore beunderstood that, after buttress assembly (5300) is secured to tissue bystaples (90), buttress assembly (5300) will be extensible along a paththat is parallel to the longitudinal orientation of crowns (92); whilebeing substantially non-extensible along a path that is perpendicular tothe longitudinal orientation of crowns (92).

As previously noted, mesh layer (5306) includes bottom mesh portion(5324) and top mesh portion (5322). Bottom mesh portion (5324) and topmesh portion (5322) may be made out of the same or different material aswould be apparent to a person having ordinary skill in the art in viewof the teachings herein. However, in the present example, top meshportion (5322) has a greater density as compared to bottom mesh portion(5324). The high density of top mesh portion (5322) provides reducedporosity of mesh layer (5306). Different densities result in differentrates of moisture absorption of bottom mesh portion (5324) and top meshportion (5322). In particular, the greater density of top mesh portion(5322) restricts the amount of moisture absorbed as compared to bottommesh portion (5324). The difference in densities between top meshportion (5322) and bottom mesh portion (5324) could be provided througha meltblown process, electrospinning, or any other methods as will beapparent to a person having ordinary skill in the art in view of theteachings herein.

Since top mesh portion (5322) is closer to adhesive layer (5304), thismay result in top mesh portion (5322) acting as a semi-permeablebarrier. In other words, fluids are somewhat restricted from passingthrough top mesh portion (5322). Therefore, if adhesive layer (5304)became viscous, top mesh portion (5322) may absorb some of viscousadhesive layer (5304) but help prevent adhesive layer (5304) frompenetrating into bottom mesh portion (5324). In addition, top meshportion (5322) may absorb some of the moisture obtained through bottommesh portion (5324) and prevent that moisture from reaching film layer(5308). In some versions, top mesh portion (5322) may provide somedegree of porosity so as to allow water moisture to pass but not allow aviscous adhesive to pass.

It should be understood that because film layer (5308) is in contactwith adhesive layer (5304) and top mesh portion (5322) is in contactwith film layer (5308), bottom mesh portion (5324) will be the portionof multilayer buttress body (5202) in contact with tissue (T₁, T₂) whenend effector (40) clamps, severs, and staples tissue (T₁, T₂) asdescribed above when utilizing multilayer buttress assembly (5300).Therefore, film layer (5208) will be closer to underside (65) of anvil(60) and/or deck (73) of staple cartridge (70). If multilayer buttressassembly (5300) is used on both underside (65) of anvil (60) and deck(73) of staple cartridge (70), a pair of film layers (5308) would besurrounding both tissue (T₁, T₂) and mesh layers (5206). This geometrysurrounding tissue (T₁, T₂) may help prevent tissue (T₁, T₂) fromforming an adhesion at the site of stapling and severing.

In some examples, film layer (5308) may be omitted. In such versions,top mesh portion (5322) would be directly interposed between adhesivelayer (5304) and bottom mesh portion (5324). Top mesh portion (5322)could be so dense as to absorb some moisture from either bottom meshportion (5324) or adhesive layer (5304), but not allow the moisture tosaturate top mesh portion (5322). This may allow adhesive layer (5304)to properly adhere to underside (65) of anvil (60) or deck (73) ofstaple cartridge (70) for longer periods of time in a moist environment,such as a surgical site.

In some examples, top mesh portion (5322) may be so dense that bottommesh portion (5324) would not be needed. In some such versions, top meshportion (5322) would be such a tightly woven mesh that moisture from aviscous adhesive would be able to penetrate mesh layer (5306), but notsaturate mesh layer (5206).

Additionally, when end effector (40) clamps, severs, and staples tissue(T₁, T₂), staples (90) will travel through mesh layer (5306),potentially confining staple legs (94) within the matrix defined by meshlayer (5306). This confinement may allow mesh layer (5208) to helpinterlock individual staples (90) in such a way that staples (90) act asa group. The confinement of staples (90) may also allow mesh layer(5306) to absorb and distribute loads provided by driving staples (90)that would otherwise be directly transferred to tissue (T₁, T₂), whichmay help prevent tissue failure due to overstress.

Film layer (5308) is substantially the same as film layer (5208), exceptwith possible differences described below. Film layer (5308) maycomprise any suitable bioabsorbable materials, including but not limitedto PDS (polydioxanone), polyglactin 910, or polyglecaprone 25. Variousother suitable materials that may be used will be apparent to those ofordinary skill in the art in view of the teachings herein. Film layer(5308) is integrally connected to mesh layer (5306) and lies on top ofmesh layer (5306). Film layer (5308) may be integrally connected to meshlayer (5306) through a heated press, combining pressure and heat. Asmentioned above, film layer (5308) may allow loops (5326) of meshportion (5306) to extend through film layer (5308) in order for meshportion (5306) to connect with adhesive layer (5304). It should beunderstood that film layer (5308) or any of its alternatives may beutilized in any of the examples described herein. It should also beunderstood that the porosity of film layer (5308) and/or top meshportion (5322) could be sized so water moisture may pass but a viscousadhesive could not.

As shown in FIGS. 95A-95B, unlike film layer (5208), a plurality ofslits (5312) are formed in film layer (5308) in the present example.Slits (5312) accommodate longitudinal stretching of film layer (5308)with mesh layer (5306) from a rested position, as shown in FIG. 95A, toa stretched position, as shown in FIG. 95B. Therefore, film layer (5308)may stretch longitudinally with mesh portion (5306), as shown in FIGS.94A-94B. Slits (5312) allow mesh portion (5306) to extend through filmlayer (5308). Additionally, slits (5312) permit fluid communicationbetween adhesive portion (5304) and mesh portion (5306).

As can be seen in FIGS. 96-98, slits (5312) are just one of option toprovide for selective communication between adhesive portion (5304) andmesh portion (5306). In particular, FIGS. 96-98 show alternative films(5314, 5316, 5318) that are substantially similar to film layer (5308)described above. Alternative films (5314, 5316, 5318) have diamond holes(5315), circular holes (5317), and a “Z” cut holes (5319) respectively,enabling communication between adhesive portion (5304) and mesh portion(5306). However, the present examples should not be seen as limiting.Slits (5312) or holes (5315, 5317, 5319) may have any other suitableshape as will be apparent to a person having ordinary skill in the artin view of the teachings herein.

It should be understood that various techniques may be used to formslits (5312) or holes (5315, 5317, 5319) in film layer (5308). Forinstance, as shown in FIG. 99, a laser (1) may be used to form slits(5312) or holes (5315, 5317, 5319) in film layer (5308). As anothermerely illustrative example, a studded roller (52) may be used to formslits (5312) or holes (5315, 5317, 5319) in film layer (5308), as shownin FIG. 100. Here, roller (52) would roll over film layer (5308) topenetrate film layer (5308) to form slits (5312) or holes (5315, 5317,5319). Roller (52) would have a diameter and specified frequency ofstuds about the circumference to determine where slits (5312) or holes(5315, 5317, 5319) would be located on film layer (5308). As yet anothermerely illustrative example, a studded press (53) may be used to formslits (5312) or holes (5315, 5317, 5319) in film layer (5308), as shownin FIG. 101. Here, press (53) would make a plurality of slits (5312) orholes (5315, 5317, 5319) with one penetrating move. Of course, any othersuitable devices or techniques may be used to create slits (5312) orholes (5315, 5317, 5319) as will be apparent to a person having ordinaryskill in the art in view of the teachings herein.

XXV. EXEMPLARY ALTERNATIVE BUTTRESS ASSEMBLIES WITH FEATURES FORMECHANICALLY COUPLING TO STAPLE CARTRIDGE

In some instances, it may be desirable to deploy multiple, successivelines of staples (690) with buttress assemblies (100, 110) onto tissueduring a surgical operation. Such a task may require the operator toremove end effector (640) from the patient (e.g., through a trocar),remove the spent staple cartridge (670), replace the staple cartridge(670), and re-insert end effector (640) into the patient via the trocar.Before end effector (640) is re-inserted into the patient, the operatormay load a new buttress assembly (100) on anvil (60). In addition, thereplacement staple cartridge (670) may include a new buttress assembly(110). In some such instances, knife member (680) may need to sever oneor two new buttress assemblies (100, 110) each time end effector (640)is actuated. Deploying multiple successive lines of staples and buttressassemblies may thus cause stress and wear on knife member (680) and leadto operator fatigue. It may therefore desirable to reduce the amount offorce required to actuate end effector (640), and reducing stress andwear on knife member (680), by reducing or eliminating structures thatmust be severed by knife member (680) during actuation of end effector(640). Several exemplary features that will prevent knife member (680)from having to sever buttress assembly (110) during actuation of endeffector (640) are described below.

Some versions of buttress assemblies (100, 110) are removably secured toend effector (640) via an adhesive. Various examples of how adhesivesmay be used to secure buttress assemblies (100, 110) to end effector(640) are described in U.S. patent application Ser. No. 14/667,842,entitled “Method of Applying a Buttress to a Surgical Stapler,” filedMar. 25, 2015, the disclosure of which is incorporated by referenceherein. It may be desirable to secure buttress assemblies (100, 110) toend effector (640) using something other than adhesives. Variousmechanical features that may be used to removably secure buttressassembly (110) to staple cartridge (670) will be described in greaterdetail below. It should be understood that similar features may be usedto secure buttress assembly (100) to anvil (60). It should also beunderstood that buttress assemblies (100, 110) may otherwise beconfigured and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, the disclosure of which is incorporated by reference herein.

A. Buttress Assembly Including Retention Tabs

FIG. 102 shows an exemplary alternative buttress assembly (6210)removably coupled to an exemplary alternative staple cartridge (6270).In the example shown, buttress assembly (6210) is releasably andmechanically coupled to cartridge (6270) rather than being adhesivelybonded to cartridge (6270). Buttress assembly (6210) includes a pair ofopposing buttress bodies (6212). Buttresses bodies (6212) may beconfigured to be substantially similar to buttress bodies (100, 112)described above. It should be understood that upon actuation of endeffector (640), a series of staples (690) will similarly capture andretain buttress assembly (6210) against layers of tissue (T₁, T₂),thereby securing buttress assembly (6210) to tissue (T₁, T₂) in asimilar manner as shown in FIG. 6. In some examples, buttress assembly(6210) may be utilized in conjunction with buttress assembly (100) onanvil (60) such that a series of staples (690) will similarly captureand retain buttress assemblies (100, 6210) against layers of tissue (T₁,T₂), thereby securing buttress assemblies (100, 6210) to tissue (T₁, T₂)in a similar manner as shown in FIG. 6.

In the present example, one buttress body (6212) is disposed on deck(6273) on one side of channel (6272) and the other buttress body (6212)is disposed on deck (6273) on the other side of channel (6272), suchthat buttress assembly (6210) does not span across channel (6272), andsuch that knife member (680) does not cut through buttress assembly(6210) during actuation of end effector (640), thus potentially reducingthe force required by an operator to actuate end effector (640).

Staple cartridge (6270) is removably coupled to lower jaw (650) of endeffector (640). Staple cartridge (6270) is substantially similar tostaple cartridge (670) except for that staple cartridge (6270) includesa plurality of recesses (6280, 6282, 6284) for removably receivingcorresponding retention features (6286, 6288, 6290) on buttresses (6212a, 6212 b). As shown best in FIGS. 104A-104B, retention feature (6286)comprises a U-shaped tab extending from a rear portion of each buttressbody (6212) in a direction parallel to channel (6272). Tab (6286) isconfigured to fit at least partially within recess (6280). As best seenin FIG. 103, tab (6286) is configured to press fit within recess (6280)when tab (6286) is directed into recess (6280). It should be understoodthat tab (6286) may comprise a resilient material that provides a biasfor the press fit.

Retention feature (6288) comprises a tab extending away from channel(6272), at an oblique angle relative to a plane defined by the faces ofbuttresses (6212 a, 6212 b) and downwardly relative to (i.e., toward)cartridge (6270). Tab (6288) is configured to press fit within recess(6282) when tab (6286) is directed into recess (6282). In some versions,tab (6288) comprises a resilient material that provides a bias for thepress fit.

Retention feature (6290) comprises a tab extending from a distal end ofbuttress (6290) in a direction that is generally parallel to slot(6272). Tabs (6286, 6288, 6290) of the present example are configured topress fit into slots (6280, 6282, 6284), respectively, but in otherexamples tabs (6286, 6288, 6290) may be retained relative to slots(6280, 6282, 6284) in other suitable manners, such as resilient snapfitting, for example. In some examples, recesses may (6280, 6282)include a portion that extends inwardly from an outer portion of recesstoward slot (6272) in order to create further interference with tabs(6286, 6288), respectively. Similarly, in some examples, recesses (6284)may include one or more portions that extend inwardly toward a middle ofrecesses (6284) that create further interference with tabs (6290). Othersuitable configurations of recesses (6280, 6282, 6284) and tabs (6286,6288, 6290) will be apparent to persons skilled in the art in view ofthe teachings herein.

In the present example, any or all of tabs (6286, 6288, 6290) comprisethe same material or materials as buttress bodies (6212). In otherexamples, any or all of tabs (6286, 6288, 6290) may comprise a pluralityof laminate, bioabsorbable layers, which may or may not include a layerthat comprises part of buttress bodies (6212). Other suitableconfigurations and materials that tabs (6286, 6288, 6290) may comprisewill be apparent to persons skilled in the art in view of the teachingsherein.

The retention force provided between retention features (6286, 6288,6290) and recesses (686280, 6282, 6284) is sufficient to maintain theremovable coupling between buttress assembly (6210) and cartridge (6270)absent a sufficient decoupling force. However, buttress assembly (6210)is configured to decouple from cartridge (6270) in response to asufficient decoupling force input, as discussed in more detail below. Asdiscussed above with respect to the similarly operable staple cartridge(670), a wedge sled (678) translates longitudinally through cartridge(6270) in order to drive staples (690) upwardly toward anvil (60). Inthe present example, recesses (6280, 282) are positioned such thatcamming surface (679) of wedge sled (678) will to contact tabs (6286,6288) as wedge sled (678) translates through cartridge (6270), andthereby urge contact tabs (6286. 6288) upwardly out of engagement withrecesses (6280, 6282), to assist in decoupling buttress assembly (6210)from cartridge (6270).

More particularly, as shown in the transition from FIG. 104A to FIG.104B, as wedge sled (678) translates longitudinally through cartridge(670) as discussed above, cam surface (679) of sled (678) is urgedagainst tab (6286), thus urging tab (6286) out of recess (6280) and awayfrom cartridge (6270). As sled (678) advances further longitudinally,cam surface (679) of wedge sled (678) is urged against tab (6288), thusurging tab (6288) and a more distal portion of buttress assembly (6210)out of recess (6282) and away from cartridge (6270). Thus, the upwardcamming force provided by cam surface (679) of sled (678) assists inreleasing buttress assembly (6210) from cartridge (6270) such that therelease of buttress assembly (6210) from cartridge (6270) does not relymostly or entirely on being captured by staples (690). In some examples,however, the upward force associated with being captured by staples(690) may be sufficient to release buttress assembly (6210) fromcartridge (6270). Tabs (6290) are released from recesses (6284) as themore distal portions of buttress bodies (6212) are captured by staples(690).

B. Buttress Assemblies Including Slots for Engaging with ConnectorMembers on Cartridge Deck

FIGS. 105-109 show an exemplary alternative buttress assembly (6310)comprising a buttress body (6312) that is removably coupled to anexemplary alternative staple cartridge (6370). In the example shown,buttress assembly (6310) is releasably and mechanically coupled tocartridge (6370) rather than being adhesively bonded to cartridge(6370). Buttress body (6312) may be configured to be substantiallysimilar to buttress (112) described above. It should be understood thatupon actuation of end effector (640), a series of staples (690) willsimilarly capture and retain buttress assembly (6310) against layers oftissue (T₁, T₂), thereby securing buttress assembly (6310) to tissue(T₁, T₂) in a similar manner as shown in FIG. 6. In some examples,buttress assembly (6310) may be utilized in conjunction with buttressassembly (100) on anvil (60) such that a series of staples (690) willsimilarly capture and retain buttress assemblies (100, 6310) againstlayers of tissue (T₁, T₂), thereby securing buttress assemblies (100,6310) to tissue (T₁, T₂) in a similar manner as shown in FIG. 6.

Cartridge (6370) is removably coupled to lower jaw (650) of end effector(640). Cartridge (6370) is configured to be substantially similar tocartridge (670) discussed above, except for that cartridge (6370)includes connector members (6380) at opposing portions of cartridge deck(6373) that, as discussed in further detail below, releasably andmechanically couple buttress assembly (6310) to cartridge deck (6373).

As best seen in FIGS. 106-107, buttress (6312) comprises a proximal end(6314), a distal end (6316), with a tapered portion (6318) towardproximal end (6314). Buttress (6312) also includes an elongate slot(6313) extending between the proximal and distal ends, a rectangularproximal recess (6324), and a rectangular distal recess (6326). Slot(6313) and recesses (6324, 6326) are positioned and configured tocorrespond to channel (6372), such that the majority of buttress (6312)does not span across channel (6372), and such that knife member (680)does not cut through buttress (6312) during actuation of end effector(640). Buttress (6312) further includes a proximal slot (6320) and adistal slot (6322) which, as discussed below, are configured assist incoupling buttress (6312) to cartridge (6370). In the present example,slots (6320, 6322) extend perpendicularly relative to a longitudinalaxis (6327) of buttress body (6312).

As best seen in FIG. 105, connector member (6380) includes a first end(6382) with a head (6384) including an aperture (6386), a notch (6387),a middle portion (6388), and a second end (6390) including opposing legs(6392). In the present example, head (6384) has a diamond shape, thoughit should be understood that head (6384) may have any other suitableshape, including but not limited to the shapes of the various exemplaryalternative heads (6884 a-8841) shown in FIGS. 114-125. In the presentexample, connector members (6380) are bonded to cartridge deck (6373) byvarious suitable methods including, but not limited to, adhesives. Inaddition or in the alternative, legs (6392) may be fitted intocorresponding slots (not shown) in cartridge (6370) and may be securedin those slots using any suitable features and techniques as will beapparent to those of ordinary skill in the art in view of the teachingsherein. As shown, connector member (6380) at the proximal end ofcartridge (6370) is oriented such that head (6384) points in a distaldirection, and connector member (6380) at the distal end of cartridge(6370) is oriented such that head (6384) points in a proximal direction.

FIG. 108 shows one manner of removably coupling buttress body (6212) toconnector portions (6380). As shown, an operator may direct the proximalend (6314) of buttress body (6312) toward connector portion (6380) suchthat head (6384) enters slot (6320) (in a direction parallel to axis(6327)) on second side (6330) of buttress body (6312), until a trailingedge (6394) of connector portion (6380) extends out of slot (6320).Similarly, an operator may direct the distal end (6316) of buttress(6312) toward the other connector portion (6380) such that head (6384)enters slot (6322) (in a direction parallel to axis (6327)) on firstside of buttress body (6312), until a trailing edge (6394) of connectorportion (6380) extends out of slot (6322), and slot (6322) engages withnotch (6387). Due to the configuration of slots (6320, 6322) and head(6384), proximal end (6314) of buttress body (6312) is substantiallyprevented from moving in the proximal direction, and distal end (6316)of buttress body (6312) is substantially prevented from moving in thedistal direction. Thus, the releasable mechanical coupling betweenbuttress body (6312) and connector portions (6380) substantiallyprevents proximal and distal movement of buttress body (6312).

The retention force provided by the engagement between connectorportions (6380) and slots (6320, 6322) is sufficient to maintain theremovable coupling between buttress assembly (6310) absent a sufficientdecoupling force. However, buttress assembly (6210) is configured todecouple from cartridge (6370) in response to a sufficient decouplingforce input. In the present example, the upward force associated withbeing captured by staples (690) provides sufficient decoupling force torelease buttress assembly (6310) from connector portions (6380) ofcartridge (6370), as discussed in further detail below.

As noted above, due to the presence of elongate slot (6313), one portionof buttress body (6312) is disposed on deck (6373) on one side ofchannel (6372) and another portion of buttress body (6312) is disposedon deck (6373) on the other side of channel (6372), such that only aportion of buttress body (6312) spans across channel (6372). Therefore,the effort required to actuate end effector (640) and sever and stapletissue is reduced. As end effector (640) is actuated and staples (690)capture buttress body (6312), the portion of buttress body (6312) nearslot (6320) is driven upwardly and slips out of engagement withconnector portion (6380). Substantially contemporaneously, knife member(680) may sever the portion of buttress body (6312) near slot (6320) aswell as connector portion (6380). By way of example only, connectorportion (6380) may be constructed of any suitable material that may besevered by knife member (680), including but not limited to a thinplastic film, a non-woven mesh, a paper-like material, and/or any othersuitable kind(s) of material(s) having any suitable form as will beapparent to those of ordinary skill in the art in view of the teachingsherein. As knife member (680) and sled (678) travel furtherlongitudinally, proximal portion of buttress body (6312) is captured bystaples (690) and subjected to a sufficient decoupling force, and isthus urged away from and out of engagement with other connector portion(6380).

FIGS. 110-113 show exemplary alternative buttress assemblies (6410, 510,610, 6710), connector portions (6480, 580, 680, 6780), and staplecartridges (6470, 570, 670, 6770), respectively, that are configured tooperate substantially similarly to buttress assembly (6310), connectorportion (6380), and staple cartridge (670, 6370), except for thedifferences below. In each of the examples shown in FIGS. 110-113,cartridges (6470, 570, 670, 6770) are removably coupled to lower jaw(650) of end effector (640). It should be understood that upon actuationof end effector (640), a series of staples (690) will similarly captureand retain buttress assembly (6410, 510, 610, 6710) against layers oftissue (T₁, T₂), thereby securing buttress assembly (6410, 510, 610,6710) to tissue (T₁, T₂) in a similar manner as shown in FIG. 6. In someexamples, buttress assembly (6410, 510, 610, 6710) may be utilized inconjunction with buttress assembly (100) on anvil (60) such that aseries of staples (690) will similarly capture and retain buttressassembly (100) and a buttress assembly (6410, 510, 610, 6710) againstlayers of tissue (T₁, T₂), thereby securing buttress assemblies (100)and buttress assembly (6410, 510, 610, 6710) to tissue (T₁, T₂) in asimilar manner as shown in FIG. 6.

As shown in FIG. 110, two connector portions (6480 a, 6480 b) areadhesively bonded to cartridge deck (6473), though other manners ofcoupling connector portions (6480 a, 6480 b) to deck (6473) will beapparent to persons skilled in the art in view of the teachings herein.In the example shown, proximal connector portion (6480 a) includes afirst end (6482 a) with a head (6484 a) that is triangularly shaped.Alternative examples of head (6484 a) may include any other suitableshape, including the shapes of any one of alternative heads (6884a-8841) shown in FIGS. 114-125. Second end (6486 a) includes a taperedportion to accommodate the shape of lower jaw (650), as well for thetravel of knife member (680) through channel (6472). Similarly, distalconnector portion (6480 b) includes a first end (6482 b) with a head(6484 b) that is triangularly shaped. Alternative examples of head (6484b) may include any other suitable shape, including the shapes of any oneof alternative heads (6884 a-8841) shown in FIGS. 114-125. Second end(6486 b) includes a shape that is substantially similar to an endportion of cartridge (6470) and covers a distal portion of channel(6472).

Buttress body (6412) includes an elongate slot (6413) extending betweena proximal end (6414) and a distal end (6416). Although not shown,buttress body (6412) includes proximal and distal slots (similar toproximal and distal slots (6320, 6322)) that extend perpendicularlyrelative to axis (6427) of buttress body (6412). Buttress body (6412) ofthe present example includes a distal recess (6426) that is longer thandistal recess (6326). Buttress body (6412) may be removably coupled tocartridge (6470) via connector portions (6480 a, 6480 b) in a similarmanner as buttress body (6312) and connector portions (6380). That is,buttress body (6412) may be directed into engagement with a first one ofthe connector portions (6480 a, 6480 b) such that that one of the heads(6484 a, 6484 b) enters a respective one of the slots (in a directionparallel to axis (6427)) on first side of buttress body (6312) and theslot engages with notch (not shown). Then, another side of buttress body(6412) may be directed into engagement with a second one of theconnector portions (6480 a, 6480 b) such that that one of the heads(6484 a, 6484 b) enters a respective one of the slots (in a directionparallel to axis (6427)), and the other slot engages with notch (notshown). Due to the configuration of slots and heads (6484 a, 6484 b),proximal end (6414) of buttress body (6412) is substantially preventedfrom moving in the proximal direction, and distal end (6416) of buttressbody (6412) is substantially prevented from moving in the distaldirection. Thus, the releasable mechanical coupling between buttressbody (6412) and connector portions (6480 a, 6480 b) substantiallyprevents proximal and distal movement of buttress body (6412).

The retention force provided by the engagement between connectorportions (6480 a, 6480 b) and slots (6420, 6422) is sufficient tomaintain the removable coupling between buttress assembly (6410) andcartridge (6470) absent a sufficient decoupling force. However, buttressassembly (6410) is configured to decouple from cartridge (6470) inresponse to a sufficient decoupling force input. In the present example,the upward force associated with being captured by staples (690)provides sufficient decoupling force to release buttress assembly (6410)from connector portions (6480 a, 6480 b) of cartridge (6470), asdiscussed in further detail below.

As shown, one portion of buttress body (6412) is disposed on deck (6473)on one side of channel (6472) and another portion of buttress body(6412) is disposed on deck (6473) on the other side of channel (6472),such that only a portion of buttress body (6312) spans across channel(6472). Therefore, the effort required to actuate end effector (640) andsever and staple tissue is reduced. As end effector (640) is actuatedand staples (690) capture buttress body (6412), the portion of buttressbody (6412) near the proximal slot and connector portion (6480 a) isdriven upwardly and slips out of engagement with connector portion (6480a). Substantially contemporaneously, knife member (680) may sever theportion of buttress body (6412) near connector portion (6480 a), as wellas connector portion. As knife member (680) and sled (678) travelfurther longitudinally, proximal portion of buttress body (6312) iscaptured by staples (690) and is thus urged away from and out ofengagement with other connector portion (6480 b). However, due to themore proximal position of connector portion (6480 b) (relative to theexample shown in FIG. 109), connector portion (6480 b) may also besevered as knife member (680) and sled (678) advance longitudinallyfurther.

Referring to FIG. 111, buttress assembly (6510) includes a pair ofbuttress bodies (6512). As shown, one buttress body (6512) is disposedon deck (6573) on one side of channel (6572) and the other buttress body(6512) is disposed on deck (6573) on the other side of channel (6572),such that buttress assembly (6510) does not span across channel (6572),and such that knife member (680) does not sever buttress assembly (6210)during actuation of end effector (640), thus potentially reducing theforce required by an operator to actuate end effector (640). In theexample shown, buttress bodies (6512) each include a proximal slot(6520) and a distal slot (6522) extending perpendicularly relative toaxis (6527) of buttress assembly (6510).

Staple cartridge (6570) includes exemplary alternative connector members(6580) on each side of channel (6572) and at each end of cartridge(6570). As shown, each connector member (6580) includes a first end(6582) with a head (6584) including an aperture (6586), a notch (6587),and a second end portion (6590). Alternative examples of head (6584) mayinclude any other suitable shape, including the shapes of any one ofalternative heads (6884 a-8841) shown in FIGS. 114-125.

To couple a buttress body (6512) to a set of connector portions (6580),proximal end (6514) of buttress body (6512) may be directed towardconnector portion (6580) such that head (6584) enters slot (6520) (in adirection parallel to axis (6527)) on second side of buttress body(6512), until a trailing edge of connector portion (6580) extends out ofslot (6520) and slot (6520) engages with notch (6587). Similarly, anoperator may direct the distal end (6516) of buttress (6512) toward theother connector portion (6580) such that head (6584) enters slot (6522)(in a direction parallel to axis (6527)) on first side of buttress body(6512), until a trailing edge of connector portion (6580) extends out ofslot (6522), and slot (6522) engages with notch (6587). As shown,connector member (6380) at the proximal end of cartridge (6570) isoriented such that head (6584) points in a distal direction, andconnector member (6580) at the distal end of cartridge (6570) isoriented such that head (6584) points in a proximal direction. Due tothe configuration of slots (6520, 522) and head (6584), proximal end(6514) of buttress body (6512) is substantially prevented from moving inthe proximal direction, and distal end (6516) of buttress body (6512) issubstantially prevented from moving in the distal direction. Thus, thereleasable mechanical coupling between buttress bodies (6512) andconnector portions (6580) substantially prevents proximal and distalmovement of buttress body (6512).

The retention force provided by the engagement between connectorportions (6580) and slots (6520, 522) is sufficient to maintain theremovable coupling between buttress assembly (6510) and cartridge (6570)absent a sufficient decoupling force. However, buttress assembly (6510)is configured to decouple from cartridge (6570) in response to asufficient decoupling force input. In the present example, the upwardforce associated with being captured by staples (690) providessufficient decoupling force to release buttress assembly (6510) fromconnector portions (6580) of cartridge (6570), as discussed in furtherdetail below.

As shown, one buttress body (6512) is disposed on deck (6573) on oneside of channel (6572) and another portion of buttress body (6512) isdisposed on deck (6573) on the other side of channel (6572), such thatno portion of buttress bodies (6512) spans across channel (6572).Therefore, the effort required to actuate end effector (640) and severand staple tissue is reduced. As end effector (640) is actuated andstaples (690) capture buttress body (6512), the portion of buttress body(6512) near the proximal slot (6520) and connector portions (6580) isdriven upwardly and slips out of engagement with connector portion(6580). As knife member (680) and sled (678) travel furtherlongitudinally, proximal portion (6514) of buttress body (6512) iscaptured by staples (690) and the portion of buttress body (6512) nearthe distal slot (6522) is driven upwardly and slips out of engagementwith connector portion (6580). Due to the positions of the buttressbodies (6512) and connector portions (6580) away from channel (6572),knife member (6580) does not sever any of buttress bodies (6512) orconnector portions.

FIG. 112 shows another exemplary alternative buttress assembly (6610) incombination with an exemplary alternative staple cartridge (6670)including exemplary alternative connector portions (6680). Buttressassembly (6610) is substantially identical to buttress assembly (6510)discussed above, except for that buttress bodies (6612) include slots(6620, 6622) that extend at an oblique angle (θ) relative to thelongitudinal axis (6627) of buttress assembly (6610).

Staple cartridge (6670) includes exemplary alternative connector members(6680), each of which extends partially along channel (6672) in a mannerso as not to impede traversal of knife member (680) therethrough. Asshown, each connector member (6580) includes a first end (6682) with ahead (6684) including an aperture (6686), a notch (6687), and a secondend portion (not shown) extending downwardly relative to staple deck(6673) Alternative examples of head (6684) may include any othersuitable shape, including the shapes of any one of alternative heads(6884 a-6884 l) shown in FIGS. 114-125.

To couple a buttress body (6612) to a set of connector portions (6680),proximal end (6614) of buttress body (6612) is directed toward connectorportion (6680) such that head (6384) enters slot (6620) (in a directiontransverse to axis (6627)) on second side of buttress body (6612), untila trailing edge of connector portion (6680) extends out of slot (6620)and slot (6620) engages with notch (6687). Similarly, an operator maydirect the distal end (6616) of buttress (6612) toward the otherconnector portion (6680) such that head (6684) enters slot (6622) (in adirection transverse to axis (6627)) on first side of buttress body(6612), until a trailing edge of connector portion (6680) extends out ofslot (6622), and slot (6622) engages with notch (6687). As shown,connector member (6680) at the proximal end of cartridge (6670) isoriented such that head (6684) points in a distal direction at angle (θ)relative to axis (6627), and connector member (6680) at the distal endof cartridge (6670) is oriented such that head (6684) points in aproximal direction at an angle (θ) relative to axis (6627). Due to theconfiguration of slots (6620, 6622) and head (6684), proximal end (6614)of buttress body (6612) is substantially prevented from moving in theproximal and distal directions (parallel to axis (6627)), and distal end(6616) of buttress body (6612) is substantially prevented from moving inthe proximal and distal directions (parallel to axis (6627)). Thus, thereleasable mechanical coupling between buttress bodies (6612) andconnector portions (6680) substantially resists proximal and distalmovement of buttress body (6612).

The retention force provided by the engagement between connectorportions (6680) and slots (6620, 6622) is sufficient to maintain theremovable coupling between buttress assembly (6610) and cartridge (6670)absent a sufficient decoupling force. However, buttress assembly (6610)is configured to decouple from cartridge (6670) in response to asufficient decoupling force input. In the present example, the upwardforce associated with being captured by staples (690) providessufficient decoupling force to release buttress assembly (6610) fromconnector portions (6680) of cartridge (6670), as discussed in furtherdetail below.

As shown, one buttress body (6612) is disposed on deck (6673) on oneside of channel (6672) and another portion of buttress body (6612) isdisposed on deck (6673) on the other side of channel (6672), such thatno portion of buttress body (6612) spans across channel (6672).Therefore, the effort required to actuate end effector (640) and severand staple tissue is reduced. As end effector (640) is actuated andstaples (690) capture buttress body (6612), the portion of buttress body(6612) near the proximal slot (6620) and connector portions (6680) isdriven upwardly and slips out of engagement with connector portion(6680). As knife member (680) and sled (678) travel furtherlongitudinally, proximal portion of buttress body (6612) is captured bystaples (690) and the portion of buttress body (6612) near the distalslot (6622) is driven upwardly and slips out of engagement withconnector portion (6680). Due to the positions of the buttress bodies(6612) and connector portions (6680) away from channel (6672) knifemember (6680) does not sever any of buttress bodies (6612) or connectorportions (6680).

FIG. 113 shows another exemplary alternative buttress assembly (6710) incombination with an exemplary alternative staple cartridge (6770)including exemplary alternative connector portions. Buttress assembly(6710) is substantially identical to buttress assembly (6510, 610)discussed above, except for that buttress bodies (6712) include slots(6720, 6722) that extend parallel to the longitudinal axis (6727) ofbuttress assembly (6710).

Staple cartridge (6770) includes exemplary alternative connector members(6780), each of which extends partially along channel (6772) in a mannerso as not to impede traversal of knife member (680) therethrough. Asshown, each connector member (6580) includes a first end (6782) with ahead (6784) including an aperture (6786), a notch (6787), and a secondend portion (6790) extending transversely relative to axis (6727). Asshown in the present example, each second end portion (6790) extendsacross channel (6772). Thus, each connector member (6780) spans channel(6772) in an opposite direction relative to an adjacent connector member(6780). Thus, heads (6784) of adjacent connector portions (6780) extendin offset, opposite, and parallel directions. Alternative examples ofhead (6784) may include any other suitable shape, including the shapesof any one of alternative heads (6884 a-8841) shown in FIGS. 114-125.Other suitable configurations of connector members (6780) will beapparent to persons skilled in the art in view of the teachings herein.

To couple a buttress body (6712) to a set of connector portions (6780),proximal end (6714) of buttress body (6712) is directed toward connectorportion (6780) such that head (6784) enters slot (6720) (in a directionperpendicular to axis (6727)) on second side of buttress body (6712),until a trailing edge of connector portion (6780) extends out of slot(6720) and slot (6720) engages with notch (6787). Similarly, an operatormay direct the distal end (6716) of buttress (6712) toward the otherconnector portion (6780) such that head (6784) enters slot (6722) (in adirection perpendicular to axis (6727)) on first side of buttress body(6712), until a trailing edge of connector portion (6780) extends out ofslot (6722), and slot (6722) engages with notch (6787). Due to theconfiguration of slots (6720, 6722) and head (6784), proximal end (6714)of buttress body (6712) is substantially prevented from moving in theproximal and distal directions (parallel to axis (6727)), and distal end(6716) of buttress body (6712) is substantially prevented from moving inthe proximal and distal directions (parallel to axis (6727)). Thus, thereleasable mechanical coupling between buttress bodies (6712) andconnector portions (6580) substantially prevents proximal and distalmovement of buttress body (6712).

The retention force provided by the engagement between connectorportions (6780) and slots (6720, 6722) is sufficient to maintain theremovable coupling between buttress assembly (6710) and cartridge (6770)absent a sufficient decoupling force. However, buttress assembly (6710)is configured to decouple from cartridge (6770) in response to asufficient decoupling force input. In the present example, the upwardforce associated with being captured by staples (690) providessufficient decoupling force to release buttress assembly (6710) fromconnector portions (6780) of cartridge (6770), as discussed in furtherdetail below.

As shown, one buttress body (6712) is disposed on deck (6773) on oneside of channel (6772) and another portion of buttress body (6712) isdisposed on deck (6773) on the other side of channel (6772), such thatno portion of buttress body (6712) spans across channel (6772). However,second end portions (6790) span channel (6772). Nonetheless, the effortrequired to actuate end effector (640) and sever and staple tissue isreduced. As end effector (640) is actuated and staples (690) capturebuttress body (6712), the portion of buttress body (6712) near theproximal slot (6720) and connector portions (6780) is driven upward andslips out of engagement with connector portion (6780). As knife member(680) and sled (678) travel further longitudinally, proximal portion ofbuttress body (6712) is captured by staples (690) and the portion ofbuttress body (6712) near the distal slot (6722) is driven upward andslips out of engagement with connector portion (6780). Due to thepositions buttress bodies (6712) being away from channel (6772), knifemember (680) does not sever any of buttress bodies (6712).

C. Buttress Assemblies with Attachment Members for Engaging with StapleCartridge Deck

FIGS. 126 and 129-131 show an exemplary alternative staple cartridge(6970) incorporated into lower jaw (650) of end effector (640). Staplecartridge (6970) is configured to operate substantially similar tostaple cartridge (670), except for the differences below. Particularly,staple cartridge (6970) includes a pair of apertures (6990) positionedproximal to staple openings (6945). Apertures (6990) are configured toreceive attachment features (6980) of a buttress assembly (6910) inorder to removably and mechanically couple buttress assembly (6910), asdiscussed in further detail below.

As shown best in FIGS. 127-128, buttress assembly (6910) includes abuttress body (6912) including a proximal end (6914), a distal end(6916), and a plurality of apertures (6918) extending along an axis(6927) thereof. Apertures (6916) may reduce the amount of force requiredfor knife member (680) to cut through and traverse past severed tissueand buttress body (6912). While four apertures (6918) are shown in thepresent example, in alternative examples there may be less than (e.g.,three, two, one, or zero) or more than four apertures (6918). Othersuitable configurations of apertures (6918) will be apparent to personsskilled in the art in view of the teachings herein.

As shown, at the proximal end (6914), attachment members (6980) extendproximally from buttress body (6912). Particularly, attachment members(6980) include a first portion (6982) extending in a perpendiculardirection away from buttress body (6912), and a second portion (6984)extending proximally away from first portion (6982) and parallel tobuttress body (6912). In the present example, any or all of attachmentmembers (6980) comprise the same material or materials as buttress body(6912). In other examples, any or all of attachment members (6980) maycomprise a plurality of laminate, bioabsorbable layers, which may or maynot include a layer that comprises part of buttress body (6912). Othersuitable configurations and materials that attachment members (6980) maycomprise will be apparent to persons skilled in the art in view of theteachings herein.

In order to removably couple buttress assembly (6910) to cartridge(6970), an operator may direct the second portions (6984) of attachmentmembers (6980) into apertures (6990) proximally and downwardly throughapertures (6990) until the first portion (6982) enters apertures (6990)and the bottom face (6913) of buttress body (6912) is flush withcartridge deck (6973). In the present example, apertures (6990) arepositioned on cartridge (6970), and attachment members are sized andconfigured such that when attachment members (6980) are directed intoapertures (6990), attachment members (6980) are releasably held betweenan underneath portion (6973 a) of deck (6973) and rails (678 a, 678 b)of sled (678). In an alternative example, rather than being held betweenthe top of rails (678 a, 678 b) and underneath portion (6973 a) of deck(6973), attachment members may be releasably held (e.g., via aninterference fit), between the rails (678 a, 678 b) of sled.

The retention force provided by the engagement between attachmentmembers (6980), cartridge deck (6973), and sled rails (678 a, 678 b) issufficient to maintain the removable coupling between buttress assembly(6910) and cartridge (6770) absent a sufficient decoupling force.However, buttress assembly (6910) is configured to decouple fromcartridge (6970) in response to a sufficient decoupling force input. Inthe present example, longitudinal movement of sled (678) disengages sledrails (678 a, 678 b) from second portion, reducing the retention forcebetween sled rails (678 a, 678 b), cartridge deck (6973), and attachmentmembers. Moreover, the upward force associated with being captured bystaples (690) provides sufficient decoupling force to release buttressassembly (6910) from connector portions (6980) of cartridge (6970), asdiscussed in further detail below.

It should be understood that upon actuation of end effector (640), aseries of staples (690) will similarly capture and retain buttressassembly (6910) against layers of tissue (T₁, T₂), thereby securingbuttress assembly (6910) to tissue (T₁, T₂) in a similar manner as shownin FIG. 6. In some examples, buttress assembly (6910) may be utilized inconjunction with buttress assembly (100) on anvil (60) such that aseries of staples (690) will similarly capture and retain buttressassemblies (100, 6910) against layers of tissue (T₁, T₂), therebysecuring buttress assemblies (100, 6910) to tissue (T₁, T₂) in a similarmanner as shown in FIG. 6.

FIGS. 132 and 135-136 show an exemplary alternative staple cartridge(61070) incorporated into lower jaw (650) of end effector (640). Staplecartridge (61070) is configured to operate substantially similar tostaple cartridge (670), except for the differences below. Particularly,staple cartridge (61070) includes a pair of apertures (61090) positionedproximal to staple openings (6545). Apertures (61090) are configured toreceive attachment features (6108066108 0) of a buttress assembly(61010) in order to removably and mechanically couple buttress assembly(61010), as discussed in further detail below.

As shown best in FIGS. 133-134, buttress assembly (61010) includes abuttress body (61012) having a proximal end (61014), a distal end(61016), and a plurality of apertures (61018) extending along an axis(1027) thereof. Apertures (61016) may reduce the amount of forcerequired for knife member (680) to cut through and traverse past severedtissue and buttress body (61012). While four apertures (61018) are shownin the present example, in alternative examples there may be less than(e.g., three, two, one, or zero) or more than four apertures (61018).Other suitable configurations of apertures (61018) will be apparent topersons skilled in the art in view of the teachings herein.

As shown, attachment members (6108066108 0) include a first portion(6108266108 2) extending in a perpendicular direction away from proximalend (61014) of buttress body (61012), and a second portion (61084)extending perpendicularly away from first portion (6108266108 2) towarddistal end (61016) and parallel to buttress body (61012). In the presentexample, any or all of attachment members (6108066108 0) comprise thesame material or materials as buttress body (61012). In other examples,any or all of attachment members (6108066108 0) may comprise a pluralityof laminate, bioabsorbable layers, which may or may not include a layerthat comprises part of buttress body (61012). Other suitableconfigurations and materials that attachment members (6108066108 0) maycomprise will be apparent to persons skilled in the art in view of theteachings herein.

In order to removably couple buttress assembly (61010) to cartridge(61070), an operator may direct the second portions (61084) ofattachment members (6108066108 0) into apertures (61090) distally anddownwardly through apertures (61090) until the first portion (61082661082) may enter apertures (61090) and the bottom face (61013) of buttressbody (61012) is flush with cartridge deck (61073). In the presentexample, apertures (61090) are positioned on cartridge (61070), andattachment members are sized and configured such that when attachmentmembers (6108066108 0) are directed into apertures (61090), attachmentmembers (6108066108 0) are releasably held between an underneath portion(61073 a) of deck (61073) and rails (678 a, 678 b) of sled (678).

The retention force provided by the engagement between attachmentmembers (6108066108 0), cartridge deck (61073), and sled rails (678 a,678 b) is sufficient to maintain the removable coupling between buttressassembly (61010) and cartridge (61070) absent a sufficient decouplingforce. However, buttress assembly (61010) is configured to decouple fromcartridge (61070) in response to a sufficient decoupling force input. Inthe present example, longitudinal movement of sled (678) disengages sledrails (678 a, 678 b) from second portion, reducing the retention forcebetween sled rails (678 a, 678 b), cartridge deck (61073), andattachment members. Moreover, the upward force associated with beingcaptured by staples (690) provides additional and sufficient decouplingforce to release buttress assembly (61010) from connector portions(6108066108 0) of cartridge (61070), as discussed in further detailbelow.

It should be understood that upon actuation of end effector (640), aseries of staples (690) will similarly capture and retain buttressassembly (61010) against layers of tissue (T₁, T₂), thereby securingbuttress assembly (61010) to tissue (T₁, T₂) in a similar manner asshown in FIG. 6. In some examples, buttress assembly (61010) may beutilized in conjunction with buttress assembly (100) on anvil (60) suchthat a series of staples (690) will similarly capture and retainbuttress assemblies (100, 61010) against layers of tissue (T₁, T₂),thereby securing buttress assemblies (100, 61010) to tissue (T₁, T₂) ina similar manner as shown in FIG. 6.

FIGS. 137 and 140-141 show an exemplary alternative staple cartridge(61170) incorporated into lower jaw (650) of end effector (640). Staplecartridge (61170) is configured to operate substantially similar tostaple cartridge (670), except for the differences below. Particularly,staple cartridge (61170) includes a pair of apertures (61190) positionedproximal to staple openings (61145). Apertures are configured to receiveattachment features (6180661180) of a buttress assembly (61110) in orderto removably and mechanically couple buttress assembly (61110), asdiscussed in further detail below.

As shown best in FIGS. 138-139, buttress assembly (61110) includes abuttress body (61112) having a proximal end (61114), a distal end(61116), and a plurality of apertures (61118) extending along an axis(1127) thereof. Apertures (61116) may reduce the amount of forcerequired for knife member (680) to cut through and traverse past severedtissue and buttress body (61112). While four apertures (61116) are shownin the present example, in alternative examples there may be less than(e.g., three, two, one, or zero) or more than four apertures (61116).Other suitable configurations of apertures (61116) will be apparent topersons skilled in the art in view of the teachings herein.

As shown, attachment members (6180661180) include a first portion(6182661182) extending in a perpendicular direction away from proximalend (61014) of buttress body (61112). In the present example, any or allof attachment members (6180661180) comprise the same material ormaterials as buttress body (61112). In other examples, any or all ofattachment members (6180661180) may comprise a plurality of laminate,bioabsorbable layers, which may or may not include a layer thatcomprises part of buttress body (61112). Other suitable configurationsand materials that attachment members (6180661180) may comprise will beapparent to persons skilled in the art in view of the teachings herein.

In order to removably couple buttress assembly (61110) to cartridge(61170), an operator may direct the first portions (6182661182) ofattachment members (6180661180) into apertures (61190) downwardlythrough apertures (61190) (in a direction perpendicular to deck (61173))until the bottom face (1113) of buttress body (61112) is flush withcartridge deck (61173). In the present example, apertures (61190) arepositioned on cartridge (61170), and attachment members (6180661180) aresized and configured such that when attachment members (6180661180) aredirected into apertures (61190), each attachment member (6180661180) isreleasably held between each rail (678 a, 678 b) of sled (678). In theexample shown, each attachment member (6180661180) is interference fitin between each set of sled rails (678 a, 678 b), but may alternativelybe releasably held in other suitable manners.

The retention force provided by the engagement between attachmentmembers (6180661180) and sled rails (678 a, 678 b) is sufficient tomaintain the removable coupling between buttress assembly (61110) andcartridge (61170) absent a sufficient decoupling force. However,buttress assembly (61110) is configured to decouple from cartridge(61170) in response to a sufficient decoupling force input. In thepresent example, longitudinal movement of sled (678) disengages sledrails (678 a, 678 b) from attachment members (6180661180), reducing oreliminating the retention force between sled rails (678 a, 678 b) andattachment members (6180661180). Moreover, the upward force associatedwith being captured by staples (690) provides additional and sufficientdecoupling force to release buttress assembly (61110) from connectorportions (6180661180) of cartridge (61170), as discussed in furtherdetail below.

It should be understood that upon actuation of end effector (640), aseries of staples (690) will similarly capture and retain buttressassembly (61110) against layers of tissue (T₁, T₂), thereby securingbuttress assembly (61110) to tissue (T₁, T₂) in a similar manner asshown in FIG. 6. In some examples, buttress assembly (61110) may beutilized in conjunction with buttress assembly (100) on anvil (60) suchthat a series of staples (690) will similarly capture and retainbuttress assemblies (100, 61110) against layers of tissue (T₁, T₂),thereby securing buttress assemblies (100, 61110) to tissue (T₁, T₂) ina similar manner as shown in FIG. 6.

FIG. 142 shows another exemplary alternative buttress assembly (61210)releasably coupled to staple cartridge (670) via an attachment member(61280). Unlike the previous examples, staple cartridge (670) does notneed to be modified in order to accommodate an attachment member (61280)of buttress assembly (61210). In the example shown, buttress assembly(61210) comprises a buttress body (61212) extending including a proximalend (61214) and a distal end (61216). Buttress body (61212) extendsalong a longitudinal axis (61227).

In the example shown in FIG. 143, attachment member (61280 a) is in theform of a tab extending perpendicularly relative to the proximal end ofbuttress body (61212). In the present example, attachment member (61280a) comprises the same material or materials as buttress body (61212).Other suitable configurations and materials that attachment member maycomprise will be apparent to persons skilled in the art in view of theteachings herein. For example, as shown in FIG. 144, attachment member(61280 b) is substantially identical to attachment member (61280 a),except for that attachment member (61280 b) comprises a laminatematerial. Particularly, the laminate material comprises a plurality oflaminate, bioabsorbable layers, which may or may not include a layerthat comprises part of buttress body (61212). Other suitableconfigurations and materials that attachment member (61280 b) maycomprise will be apparent to persons skilled in the art in view of theteachings herein.

In order to removably couple buttress assembly (61210) to cartridge(670), an operator may direct the attachment member (61280 a, 61280 b)over the proximal end (670 a) of cartridge (670) such that attachmentmember (61280 a, 61280 b) is positioned between proximal end ofcartridge (670) and a distally facing portion of lower jaw, and untilthe bottom face (61213) of buttress body (61212) is flush with cartridgedeck (673). Attachment member (61280 a, 61280 b) is sized and configuredsuch that when attachment member (6180661180) is positioned betweenproximal end of cartridge (670) and lower jaw (650), attachment member(6180661180 a, 6118066118 0 b) is releasably held therebetween. In theexample shown, attachment member (6180661180 a, 6118066118 0 b) isinterference fit in between proximal end (670 a) of cartridge (670) andlower jaw (650). It should be understood that buttress assembly (61210)may first be positioned on cartridge (670), and then the combination ofbuttress assembly (61210) and cartridge (670) may be loaded into lowerjaw (650). Alternatively, cartridge (670) may be loaded into lower jaw(650) first; and then buttress assembly (61210) may be loaded ontocartridge (670).

The retention force provided by the engagement between attachmentmembers (61280 a, 61280 b), proximal end (670 a) of cartridge (670), andlower jaw (650) is sufficient to maintain the removable coupling betweenbuttress assembly (61210) and cartridge (670) absent a sufficientdecoupling force. However, buttress assembly (61210) is configured todecouple from cartridge (670) in response to a sufficient decouplingforce input. In the present example, the upward force associated withbeing captured by staples (690) provides additional and sufficientdecoupling force to release buttress assembly (61210) and connectorportions (61280) from engagement with cartridge (670).

FIGS. 145-146 show an exemplary variation of buttress assembly (61210)that includes alternative attachment members (61280 c). As shown, eachattachment member (61280 c) includes a pair of apertures (61290) thatare configured to receive similarly shaped extensions on sled (678).Particularly, as shown in FIGS. 145-146, each sled rail (678 a, 678 b)includes proximally projecting extensions (61295) that are sized andconfigured to be received in apertures (61290). Thus, in order toremovably couple buttress assembly (61210) including attachment members(61280 c) to cartridge (670), an operator may direct attachment member(61280 c) over the proximal end (670 a) of cartridge (670) such thatattachment member (61280 c) is positioned between proximal end ofcartridge (670) and a portion of lower jaw (650), and apertures (61290)engage the corresponding extensions (61295). Moreover, apertures (61290)and extensions (61295) are configured such that when they are engaged,the bottom face (61213) of buttress body (61212) is flush with cartridgedeck (673).

The retention force provided by the engagement between apertures (61290)of attachment members (61280 c), extensions (61295) of sled (678), andlower jaw (650) is sufficient to maintain the removable coupling betweenbuttress assembly (61210) and cartridge (670) absent a sufficientdecoupling force. However, buttress assembly (61210) is configured todecouple from cartridge (670) in response to a sufficient decouplingforce input. In the present example, longitudinal movement of sled (678)disengages extensions (61295) from apertures (61290), reducing theretention force between sled rails (678 a, 678 b) and attachment members(61280 c). In the present example, the upward force associated withbeing captured by staples (690) provides additional and sufficientdecoupling force to release buttress assembly (61210) and connectorportions (61280) from engagement with cartridge (670).

It should be understood that upon actuation of end effector (640), aseries of staples (690) will similarly capture and retain buttressassembly (61210) against layers of tissue (T₁, T₂), thereby securingbuttress assembly (61210) to tissue (T₁, T₂) in a similar manner asshown in FIG. 6. In some examples, buttress assembly (61210) may beutilized in conjunction with buttress assembly (100) on anvil (60) suchthat a series of staples (690) will similarly capture and retainbuttress assemblies (100, 61210) against layers of tissue (T₁, T₂),thereby securing buttress assemblies (100, 61210) to tissue (T₁, T₂) ina similar manner as shown in FIG. 6.

FIGS. 147 and 149A-B show another exemplary alternative staple cartridge(61370) incorporated into lower jaw (650) of end effector (640). Staplecartridge (61370) is configured to operate substantially similar tostaple cartridge (670), except for the differences below. Particularly,staple cartridge (61370) includes an aperture (61390) positionedproximal to staple openings (61345). Aperture (61390) is formed aslateral extensions of slot (61372). Aperture (61390) and the portion ofslot (61372) that is coincident with aperture (61390) are configured toreceive attachment features (6108066108 0) of a buttress assembly(61010) in order to removably and mechanically couple buttress assembly(61010), as discussed in further detail below.

As shown best in FIGS. 147-148, buttress assembly (61310) includes apair of buttress bodies (61312) coupled to a base portion (61315). Inthe present example, each buttress body (61312) comprises a strong yetflexible material configured to structurally support a line of staples(690). By way of example only, buttress body (61312) may comprise awoven mesh of VICRYL® (polyglactin 910) material by Ethicon US, LLC, andbase portion (61315) may comprise the same or different material (e.g.,a thin film, etc.). Alternatively, any other suitable materials orcombinations of materials may be used in addition to or as analternative to VICRYL® material to form buttress body (61312) and/orbase portion (61315). Of course, buttress body (61312) and base portion(61315) may take any other suitable form and may be constructed of anyother suitable material(s).

In the present example, buttress assembly (61310) includes a proximalend (61314) and a distal end (61316) and extends along an axis (61327)thereof. As shown, buttress assembly (61310) includes attachment members(61380) extending from proximal end (61314) of base portion (61315) in aperpendicular direction away from buttress body (61012) and base portion(61315). Attachment members (61380) comprise resilient tabs thatcomprise the same material or materials as base member (61312). In otherexamples, any or all of tabs (61380) may comprise a plurality oflaminate, bioabsorbable layers, which may or may not include a layerthat comprises part of base member (61312). In some examples, any or allof resilient tabs (61380) may comprise a woven, non-woven, or foammaterial. Other suitable configurations and materials that tabs (61380)may comprise will be apparent to persons skilled in the art in view ofthe teachings herein.

In order to removably couple buttress assembly (61310) to cartridge(61370), an operator may direct resilient tabs (61380) into aperture(61390) downwardly through aperture (61390) until tabs (61380) engagesled (678), and face (61313) of buttress body (61312) is substantiallyflush with cartridge deck (61373). As shown best in FIGS. 149A-149B,tabs (61380) resiliently engage sled, thereby releasably couplingbuttress assembly (61310) to sled (678), and thereby releasably couplingbuttress assembly (61310) to cartridge (61370).

The retention force provided by the engagement between tabs (61380) andsled (678) is sufficient to maintain the removable coupling betweenbuttress assembly (61310) and cartridge (61370) absent a sufficientdecoupling force. However, buttress assembly (61310) is configured todecouple from cartridge (61370) in response to a sufficient decouplingforce input. In the present example, longitudinal movement of sled (678)disengages sled (678) from tabs (61380), releasing the retention forcebetween sled (678) and tabs (61380). Moreover, the upward forceassociated with being captured by staples (690) provides additional andsufficient decoupling force to release buttress assembly (61310) fromconnector portions (61380) of cartridge (61370).

FIG. 150 shows another alternative exemplary buttress assembly (61410).Buttress assembly (61410) is substantially similar to buttress assembly(61310) except for that resilient tabs (61480) are longitudinallystaggered. Moreover, buttress assembly (61410) includes a medial cutedge portion (61417) that facilitates severing of buttress body (61412)by knife member (680) and thus traversal of knife member (680) throughbuttress body (61412). It should be understood that upon actuation ofend effector (640), a series of staples (690) will similarly capture andretain buttress assembly (61310, 61410) against layers of tissue (T₁,T₂), thereby securing buttress assembly (61310, 61410) to tissue (T₁,T₂) in a similar manner as shown in FIG. 6. In some examples, buttressassembly (61310, 61410) may be utilized in conjunction with buttressassembly (100) on anvil (60) such that a series of staples (690) willsimilarly capture and retain buttress assemblies (100, 61310, 61410)against layers of tissue (T₁, T₂), thereby securing buttress assemblies(100, 61310, 61410) to tissue (T₁, T₂) in a similar manner as shown inFIG. 6.

D. Buttress Assemblies with Features to Facilitate Knife MemberTraversal

FIG. 151 shows an exemplary alternative buttress assembly (61510)including a pair of buttress bodies (61512) that are connected by adiagonal woven mesh (61515). While only a portion of buttress assembly(61510) is shown, it will be understood that buttress assembly (61510)may be incorporated into a suitable staple cartridge (e.g., staplecartridge (670)) of a surgical instrument (e.g., instrument (10)) andmay be utilized in steps of a surgical stapling procedure, such as thoseshown in FIGS. 5A-6. Moreover, the construction of buttress assembly(61510) may be readily incorporated into any of the various buttressassemblies described herein.

In the example shown, buttress bodies (61512) are coupled to one anothervia a woven mesh (61515) of material filaments. A first portion (61516)of filaments which the mesh (61515) comprises extend at an oblique angle(e.g., forty five degrees as shown) relative to the longitudinal axis(61527), and a second portion of filaments (61518) extend orthogonallyrelative to the first portion (61516) and at an oblique angle relativeto the longitudinal axis (61527) (e.g., forty five degrees as shown).

In the present example, filaments comprising mesh (61515) are made ofVICRYL® (polyglactin 910) material by Ethicon US, LLC. Buttress body(61512) is comprised of a film or woven mesh of VICRYL® (polyglactin910) material by Ethicon US, LLC. Alternatively, any other suitablematerials or combinations of materials may be used in addition to or asan alternative to VICRYL® material to form buttress body (61512) orfilaments of mesh (61515). Of course, buttress body (61512) and mesh(61515) may take any other suitable form and may be constructed of anyother suitable material(s).

In the present example, portions of mesh (61515) that are coincidentwith buttress bodies (61512) are bonded or otherwise coupled to a topportion of buttress bodies (61512). In addition or in the alternative,mesh (61515) may be bonded or otherwise coupled along a bottom portionof buttress bodies (61512). As another merely illustrative alternative,mesh (61515) may be at least partially impregnated within one or both ofbuttress bodies (61512). In the example shown, mesh (61515) is a wovenmesh, but in other examples, mesh (61515) may be knitted or formed inany other suitable manner. In some examples, mesh (61515) may be severedand formed using heat or other forms of energy so as to fuse thefilaments together as they are cut to, for example, prevent rough edges.Other suitable manners of coupling buttress bodies (61512) and mesh(61515) to one another, and of forming mesh (61515), will be apparent topersons skilled in the art in view of the teachings herein. In analternative example, as shown in FIG. 160, buttress body (61512) mayinclude a mesh (61515) according to the teachings just discussed, incombination with an integral film (61526).

Buttress assembly (61510) further includes two lines of perforations(61520) oriented at an oblique angle (forty-five degrees as shown) andparallel to the longitudinal axis (61527). In the present example,perforations (61520) may be formed using heat or other forms of energyso as to fuse the filaments together as they are cut to, for example,prevent rough edges. For example, filaments may be treated with anultrasonic treatment, a heated knife member, laser, and other modes oftreating with energy as will be understood by persons skilled in the artin view of the teachings herein. Perforations (61520) may also be formedin various other suitable manners as will be apparent to persons skilledin the art in view of the teachings herein.

Perforations (61520) facilitate separation of buttress bodies (61512) asknife member (680) traverses therebetween. More particularly, due to theperforations (61520), none of the filaments comprising mesh extendcompletely from one end of one buttress body to an end of the otherbuttress body (61512). Rather, the filaments extend from an edge (61522)of buttress body to one of the edges of perforations (61520), asrepresented by some of filaments extending further away from other edge(61524) of buttress body (61512) Therefore, rather than requiring knifemember (680) to sever portions of mesh (61515) extending over channel(672), for example, as knife member (680) traverses channel (672),filaments may simply be pulled out of the way as buttress bodies (61512)are captured by staples (690). Thus, stress on the severed and stapledtissue, and damage and wear on knife member (680), may be decreased.

An alternative example of a buttress assembly (61610) is shown in FIG.153. Buttress assembly (61610) is similar to buttress assembly (61510)in that in includes a woven mesh (61615). However, woven mesh (61615)includes a first portion (61616) of filaments that extend parallel tothe longitudinal axis (61627) of buttress assembly (61610), and a secondportion (61618) of filaments that extend parallel to the longitudinalaxis (61627). Mesh (61615) connects opposing buttress bodies (61612). Afirst portion (61616) of filaments that extend parallel to axis (61627)do not extend along a portion between buttress bodies (61612). Thus,first portion of filaments are not present along channel (672) ofcartridge (670) when buttress assembly (61610) is utilized with staplecartridge (670). Therefore, rather than requiring the knife member (680)to sever mesh (61515) with both portions of filament, extending overchannel (672), for example, as knife member (680) traverses channel(672), knife member (680) only severs first portion (61616)(perpendicular to axis (61627)) of filaments as buttress bodies (61612)are captured by staples (690). Thus, stress on the severed and stapledtissue, and damage and wear on knife member (680), may be decreased.

In the present example, portions of mesh (61615) that are coincidentwith buttress bodies (61612) are bonded or otherwise coupled to a topportion of buttress bodies (61612). In addition or in the alternative,mesh (61615) may be bonded or otherwise coupled along a bottom portion.As another merely illustrative alternative, mesh (61615) may be at leastpartially impregnated within one or both of buttress bodies (61612). Inthe example shown, mesh (61615) is a woven mesh, but in other examples,mesh (61615) may be knitted or formed in any other suitable manner. Insome examples, mesh (61615) may be severed and formed using heat orother forms of energy so as to fuse the filaments together as they arecut to, for example, prevent rough edges. For example, filaments may betreated with an ultrasonic treatment, a heated knife member, laser, andother modes of treating with energy as will be understood by personsskilled in the art in view of the teachings herein. Other suitablemanners of coupling buttress bodies (61612) and mesh (61615) to oneanother, and of forming mesh (61615), will be apparent to personsskilled in the art in view of the teachings herein.

FIGS. 154-150 show additional examples of buttress assemblies (61710,61810) that may be incorporated into a suitable staple cartridge (e.g.,staple cartridge (670)) of a surgical instrument (e.g., instrument (10))and may be utilized in steps of a surgical stapling procedure, such asthose shown in FIGS. 5A-6. Buttress assemblies (61710, 61810) includefeatures that may reduce the amount of effort to advance knife member(680) through channel (672) as end effector (640) is actuated. Stress onthe severed and stapled tissue, and damage and wear on knife member(680), may therefore be decreased.

As shown in FIG. 154, buttress assembly (61710) includes a buttress body(61712) including a proximal end (61714) having a proximal recess(61715), a distal end (61716) having a distal recess (61717), and aplurality of apertures (61718) extending along an axis (61727) thereof.While five apertures (61718) are shown in the present example, inalternative examples there may be less than (e.g., four, three, two,one, or zero) or more than five apertures (61718). In the presentexample, apertures (61718) are obround-shaped apertures, and recesses(61715, 61717) are half-obround recesses. Of course, any other suitableshapes may be used. Other suitable configurations of apertures (61718)and recesses (61715, 61717) will be apparent to persons skilled in theart in view of the teachings herein. Referring to FIG. 155, buttressassembly (61810) is substantially identical to buttress assembly(61710), except for that buttress assembly (61810) includes rectangularapertures (61818) and half-rectangular recesses (61815, 61817).

In the present examples, apertures (61718, 61818) and recesses (61715,61815) may reduce the amount of force required for knife member (680) tocut through and traverse past severed tissue and buttress body (61712).Thus, stress on the severed and stapled tissue, and damage and wear onknife member (680), may be decreased.

Each buttress assembly (61710, 61810) of these examples comprises abuttress body (61712, 61812) and, in some instances, an adhesive layer(not shown). In the present example, each buttress body (61712, 61812)comprises a strong yet flexible material that is configured tostructurally support a line of staples (690). By way of example only,each buttress body (61712, 61812) may comprise a woven mesh of VICRYL®(polyglactin 910) material by Ethicon US, LLC. Alternatively, any othersuitable materials or combinations of materials may be used in additionto or as an alternative to VICRYL® material to form each buttress body(61712, 61812), such as any of the materials or configurations discussedabove with respect to other disclosed buttress bodies. Of course, eachbuttress body (61712, 61812) may take any other suitable form and may beconstructed of any other suitable material(s).

FIG. 156 shows another exemplary alternative buttress assembly (61910)that may be incorporated into a suitable staple cartridge (e.g., staplecartridge (670)) of a surgical instrument (e.g., instrument (10)) andmay be utilized in steps of a surgical stapling procedure, such as thoseshown in FIGS. 5A-6. Buttress assembly (61910) includes features thatmay reduce the amount of effort to advance knife member (680) throughchannel (672) as end effector (640) is actuated. In the example shown,buttress assembly (61910) includes a pair of buttress bodies (61912)configured such that when buttress assembly (61910) is incorporated ontostaple cartridge (670), buttress bodies (61912) do not span acrosschannel (672), such that knife member (680) does not sever buttressbodies (61912) during actuation of end effector (640). Thus, stress onthe severed and stapled tissue, and damage and wear on knife member(680), may be decreased.

As shown in FIG. 156, buttress bodies (61912) are coupled to one anothervia a connector member (61915), such that knife member (670) would cutthrough at least a portion of connector member (61915). As shown,connector member (61915) comprises a sheet or thin film of material,such as wax, gelatin, or a woven or non-woven material similar to otherbuttress bodies described herein. Connector member (61915) may bethinner and/or weaker than buttress bodies (61912), such that knifemember (680) will encounter less resistance and/or suffer from less wearwhen traversing connector member (61915) than knife member (680) wouldotherwise encounter if knife member (680) were to traverse buttressbodies (61912).

In some versions, connector member (61915) provides additional thicknessto buttress bodies (61912) such that, buttress assembly (61910) providedherein may provide a tissue compression effect between anvil (60) anddeck (673) of staple cartridge (670), such as that described in U.S.patent application Ser. No. 14/810,786, entitled “Surgical StapleCartridge with Compression Feature at Knife Slot,” filed Jul. 28, 2015,the disclosure of which is incorporated by reference herein; U.S. patentapplication Ser. No. 14/811,087, entitled “Surgical Staple Cartridgewith Compression Feature at Staple Driver Edges,” filed Jul. 28, 2015,the disclosure of which is incorporated by reference herein; and U.S.patent application Ser. No. 14/811,154, entitled “Surgical StapleCartridge with Outer Edge Compression Features,” filed Jul. 28, 2015,the disclosure of which is incorporated by reference herein.

FIG. 157 shows another exemplary alternative buttress assembly (62010)that may be incorporated into a suitable staple cartridge (e.g., staplecartridge (670)) of a surgical instrument (e.g., instrument (10)) andmay be utilized in steps of a surgical stapling procedure, such as thoseshown in FIGS. 5A-6. Buttress assembly (62010) includes features thatmay reduce the amount of effort to advance knife member (680) throughchannel (672) as end effector (640) is actuated. In the example shown,buttress assembly (62010) includes a pair of buttress bodies (62012)configured such that when buttress assembly (62010) is incorporated ontostaple cartridge (670), buttress bodies (62012) do not span acrosschannel (672), such that knife member (680) does not sever buttressbodies (62012) during actuation of end effector (640). As shown,however, buttress bodies (62012) are coupled to one another via discreteconnector members (62015) that would span channel (672) whenincorporated into staple cartridge (670).

In the example shown, connector members (62015) comprise five lines ofadhesive spanning between buttress bodies (62012). However, in otherexamples, there may be fewer or more than five lines of adhesivespanning buttress bodies (62012). Moreover, in some examples, any or allof connector members (62015) might be alternatively configured. Forexample, any or all of connector members (62015) may comprise filamentimpregnated adhesive, filaments, or other elements capable ofmaintaining buttress bodies (62102) in a releasably couplablerelationship but that would not inhibit or impede the traversal of knifemember (680). As shown, buttress bodies (62012) each include discreteportions of adhesive (62021) that may be utilized to help releasablycouple buttress bodies to cartridge deck (673). As shown, discreteportions of adhesive (62021) are formed as dots and may ease the releaseof buttress bodies (62012) from deck (673) as buttress bodies (62012)are captured by staples (690) (e.g., as opposed to an entire sheet ofadhesive coupling buttress bodies (62012) to deck (673)).

FIG. 158 shows another exemplary alternative connector member (62115)that is configured to be utilized together with a buttress body, such asbuttress body (61912) just discussed, and incorporated into a suitablestaple cartridge (e.g., staple cartridge (670)) of a surgical instrument(e.g., instrument (10)) and utilized in steps of a surgical staplingprocedure, such as those shown in FIGS. 5A-6. As shown, connector member(62115) comprises a matrix-like configuration of intersecting linesforming a generally rectangular shape. Particularly, connector member(62115) includes outer portions (62116) that are configured to liecoincidently with buttress bodies (62112) and an inner portion (62118)that is configured to span channel (672), such that buttress bodies(61912) do not span channel (672). In some versions, connector member(62115) provides an added thickness to a buttress assembly such that thebuttress assembly provides a tissue compression effect between anvil(60) and lower jaw (650), such as that described in U.S. patentapplication Ser. No. 14/810,786; U.S. patent application Ser. No.14/811,087, the disclosure of which is incorporated by reference herein;and U.S. patent application Ser. No. 14/811,154, the disclosure of whichis incorporated by reference herein.

In the present example, connector member (62115) comprises a waxmaterial but in other examples, all or a portion of connector member(62115) may comprise gelatin, a woven or non-woven material similar tobuttress bodies (6210), and/or any other suitable material(s). In thepresent example, buttress bodies (61912, 62012) may comprises a strongyet flexible material configured to structurally support a line ofstaples (690). By way of example only, buttress body (61912) maycomprise a woven mesh of VICRYL® (polyglactin 910) material by EthiconUS, LLC, and base portion may comprise the same or different material.Alternatively, any other suitable materials or combinations of materialsmay be used in addition to or as an alternative to VICRYL® material toform buttress body (61912) and/or connector member portion (61915,62015). Of course, buttress body (61912) and base portion (61915) maytake any other suitable form and may be constructed of any othersuitable material(s).

FIGS. 159A-159B show another exemplary alternative buttress assembly(62210) comprising opposing buttress bodies (62212), incorporated intostaple cartridge (670) of a surgical instrument (e.g., instrument (10)),which may be utilized in steps of a surgical stapling procedure, such asthose shown in FIGS. 5A-6. By way of example only, buttress bodies(62212) may comprise a woven mesh of VICRYL® (polyglactin 910) materialby Ethicon US, LLC. Alternatively, any other suitable materials orcombinations of materials may be used in addition to or as analternative to VICRYL® material to form buttress body (62212), such asthe other configurations of buttress bodies disclosed herein.

As shown, buttress bodies (62212) are discrete members that eachpartially span channel (672). As shown in FIG. 159A, one buttress body(62212) partially overlaps the other buttress body (62212), though itwill be understood that other overlapping configurations may beutilized. Rather than having to cut through buttress assembly (62210),as knife member (680) traverses channel (672), knife member (680)displaces buttress bodies (62212) away from channel (672) as shown inFIG. 159B. In some instances, buttress bodies (6212) or knife member(680) may include a lubricious coating to reduce the friction betweensuch components. Stress on the severed and stapled tissue and damage,and wear on knife member (680), may therefore be decreased.

E. Buttress Assemblies Covering Only a Portion of Staple Cavities

FIGS. 161-162B show an exemplary alternative buttress assembly (62310).As shown best in FIG. 161, buttress assembly (62310) is disposed on astaple cartridge (62370) that is configured to operate substantiallysimilarly to staple cartridge (670) discussed above. Cartridge (62370)is removably coupled to lower jaw (650) of end effector (640). In thepresent example, staple cartridge (62370) includes three rows of staples(690) in three sets of cavities (62345) on each side of channel (62372)instead of two rows of staples cavities (62345). Moreover, cartridge(62370) includes an elongate trough (62379) extending along staple deck(62373). Trough (62379) extends longitudinally along the length ofcartridge (62370) and is laterally positioned between the outermost rowof cavities (62345) and the middle row of cavities (62345). Trough(62379) has a partially circular cross-sectional profile. In otherexamples, however, trough (62379) may have any other suitable shapeswhich as will be apparent to persons skilled in the art in view of theteachings herein.

Buttress assembly (62310) of the present example may be configured inaccordance with other buttress assemblies disclosed herein. As shown,buttress body (62312) of buttress assembly (62310) extends along deck(62373) and an end portion (62313) of buttress body (62373) is disposedin a rolled configuration within trough (62379). In the present example,end portion (62313) is biased toward an unrolled configuration, but isretained in the rolled configuration when positioned within trough(62379). Other suitable configurations of buttress assembly (62310) willbe apparent to persons skilled in the art in view of the teachingsherein.

Upon actuation of end effector (640), staples (690) capture and retainbuttress assembly (62310) against layers of tissue (T1, T2), therebysecuring buttress assembly (62310) to tissue (T1, T2) in a similarmanner as shown in FIG. 6. In the example shown in FIGS. 162A-162B,buttress assembly (62310) has been utilized in conjunction with buttressassembly (100) on anvil (60) such that a series of staples (690) hascaptured and retained buttress assemblies (100, 62310) against layers oftissue (T1, T2), thereby securing buttress assemblies (100, 62310) totissue (T1, T2) in a similar manner as shown in FIG. 6. Similar to endportion (62313) of buttress assembly (62310), an end portion of buttressassembly (100) is shown to initially be in a rolled configuration uponbeing captured onto tissue (T1, T2), with the remaining portions ofbuttress assemblies covering the two rows of staples (690) closest tochannel (62373). Thus, due to the presence of staples (690) and buttressassemblies (100, 62310) captured at the first and second rows of staples(690), there is a relatively higher level of compression at the firstand second rows of staples (690), and better profusion at the third rowof staples (690). As shown best in FIG. 162B, upon being captured ontotissue (T1, T2), ends (113, 62313) resiliently unfurl to transition toan unrolled position to cover the third row of staples (690). Buttressassemblies (100, 62310) thereby facilitate tissue ingrowth and seal anypuncture leaks, if present.

FIGS. 163-164 show an exemplary alternative buttress assembly (62410).As shown best in FIG. 163, buttress assembly (62410) is disposed on astaple cartridge (62470) that is configured to operate substantiallysimilarly to staple cartridge (670) discussed above. Cartridge (62470)is removably coupled to lower jaw (650) of end effector (640). Staplecartridge (62470) of this example includes three rows of staples (62490)in three sets of cavities (62445) on each side of channel (62472)instead of two rows of staples (62445).

Buttress assembly (62410) of the present example may be configured inaccordance with other buttress assemblies disclosed herein. Buttressbody (62412) of buttress assembly (62410) extends longitudinally alongdeck (62473) and laterally terminates at a position such that a lateraledge (62413) is between the outermost row of staple cavities (62445) andthe middle row of staple cavities (62445). Other suitable configurationsof buttress assembly (62410) will be apparent to persons skilled in theart in view of the teachings herein.

Upon actuation of end effector (640), staples (690) capture and retainbuttress assembly (62410) against layers of tissue (T1, T2), therebysecuring buttress assembly (62410) to tissue (T1, T2) in a similarmanner as shown in FIG. 6. As shown, some examples, buttress assembly(62410) has been utilized in conjunction with buttress assembly (100) onanvil (60) such that a series of staples (690) has captured and retainedbuttress assemblies (100, 62410) against layers of tissue (T1, T2),thereby securing buttress assemblies (100, 62410) to tissue (T1, T2). Asshown, lateral edge (62413) of buttress assembly (62410) is positionedbetween the outermost row of staples (690) and the intermediate row ofstaples (690). The rest of buttress assembly (62410) has been capturedby the first and second rows of staples (690). Thus, due to the presenceof staples (690) and buttress assemblies (100, 62410) captured at thefirst and second rows of staples (690), there is a relatively higherlevel of compression at the first and second rows of staples, and betterprofusion at the third row of staples (690).

FIGS. 165-166 show an exemplary alternative buttress assembly (62510).As shown best in FIG. 165, buttress assembly (62510) is disposed on astaple cartridge (62570) that is configured to operate substantiallysimilarly to staple cartridge (670) discussed above. Cartridge (62570)is removably coupled to lower jaw (650) of end effector (640). Cartridge(62570) of this example includes three rows of staples (62590) in threesets of cavities (62545) on each side of channel (62572) instead of tworows of staples (62545).

Buttress assembly (62510) of the present example may be configured inaccordance with other buttress assemblies disclosed herein. As shown,buttress body (62512) of buttress assembly (62510) extends along deck(62573) and a distal end portion (62513) of buttress body (62573)terminates such that buttress assembly (62510) does not cover a distalportion (62545 d) of staple cavities (62545); or a distal portion ofchannel (62572) or deck (62573). In other words, buttress assembly(62510) does not extend along the full length of deck (62573). Othersuitable configurations of buttress assembly (62510) will be apparent topersons skilled in the art in view of the teachings herein.

Upon actuation of end effector (640), staples (690) capture and retainbuttress assembly (62510) against layers of tissue (T1, T2), therebysecuring buttress assembly (62510) to tissue (T1, T2) in a similarmanner as shown in FIG. 6. FIG. 166 shows a plurality of buttressassemblies (62510) that have been deployed with staples (690) ontotissue, after actuating end effector (640) multiple times. Due to theconfiguration of buttress assembly (62510) terminating proximal todistal portion (62545 d), when buttress assembly (62510) and staples(690) are deployed onto tissue, a portion of stapled tissue includesstaples (690) but does not include buttress assembly (62510), such as atregion (S2). However, at region (S1), which has been severed and stapledwith successive lines of staples (690), a region (S2) of overlap occurs.Notably, due to the lack of buttress (62510) at distal portion (62545d), successive staple lines overlap (as shown by more than three rows ofstaples (690) at region (S1)), but overlapping portions of buttressassemblies (62510) are not created.

In some examples, buttress assembly (62510) may be utilized inconjunction with buttress assembly (100) on anvil (60) such that aseries of staples (690) will similarly capture and retain buttressassemblies (100, 62510) against layers of tissue (T₁, T₂), therebysecuring buttress assemblies (100, 62510) to tissue (T₁, T₂) in asimilar manner as shown in FIG. 6. Of course, buttress assembly (100) insuch instances may be modified to be configured substantially identicalto buttress assembly (62510).

XXVI. EXEMPLARY STRETCHABLE BUTTRESS ASSEMBLY FOR SURGICAL STAPLER

In some instances, it may be desirable to equip end effector (40) with abuttress assembly (100, 110) comprising a buttress body (102, 112) thatincludes an elastic material that is substantially stretchable in atleast one direction and that will substantially recover its originalshape. The resulting buttress assemblies (100, 110) may advantageouslyreinforce the mechanical fastening of tissue provided by staples (90),while moving with, rather than restraining, the underlying tissue. Suchbuttress assemblies (100, 110) may be particularly useful inapplications in which the tissue that is fastened may subsequentlyexpand and/or contract. For example, stretchable buttress assemblies(100, 110) may be of use to reinforce the mechanical fastening of acollapsed lung that is then re-inflated, and expands and contracts withthe lung during the breathing process.

In some instances where staples (90) are to applied to an anatomicalstructure that expands and contracts during normal biologicalfunctioning (e.g., a lung, etc.), end effector (40) may be modified toapply lines of staples (90) to tissue (T₁, T₂) that are also configuredto allow stretching of tissue (T₁, T₂). For instance, such a modifiedend effector (40) may be constructed and operable in accordance with atleast some of the teachings of U.S. patent application Ser. No.14/498,145, entitled “Method for Creating a Flexible Staple Line,” filedSep. 26, 2014, the disclosure of which is incorporated by referenceherein; and/or U.S. patent application Ser. No. 14/498,070, entitled“Radically Expandable Staple Line,” filed Sep. 26, 2014, the disclosureof which is incorporated by reference herein. It should be understoodthat the following variations of buttress body (102, 112) may be usedwith end effector (40) described above, with the variation of endeffector (40) described in U.S. patent application Ser. No. 14/498,145and/or U.S. patent application Ser. No. 14/498,070, and/or with anyother suitable form of end effector (40).

In illustrative examples of stretchable buttresses assemblies (100,110), the buttress bodies (102, 112) may comprise fibrous, planarfabric. “Fiber” as used herein means continuous fibers, which aresometimes referred to in the art as “substantially continuousfilaments,” “filaments,” or “yarn,” or staple fibers having an averagelength that is sufficient so that the staple fibers may be knittedand/or woven together. Fibers that are useful may be selected from thegroup consisting of: monocomponent fibers; multicomponent fibers;bicomponent fibers; biconstituent fibers; and combinations thereof.

“Monocomponent fiber” as used herein, refers to a fiber formed fromusing one or more extruders from only one polymer; this is not meant toexclude fibers formed from one polymer to which small amounts ofadditives have been added. Additives may be added to the polymer for thepurposes of providing the resulting fiber with coloration, antistaticproperties, lubrication, hydrophilicity, and/or other properties.

“Multicomponent fiber” as used herein, refers to a fiber formed from twoor more different polymers that are extruded from separate extruders andspun together to form one fiber.

“Bicomponent fibers” are one type of multicomponent fiber, and areformed from two different polymers. Bicomponent fibers may sometimes bereferred to in the art as “conjugate fibers.” Bicomponent fibers may becomprised of polymers that are substantially continuously positioned indistinct zones, both across the cross-section of the bicomponent fibersand along their length. Non-limiting examples of such bicomponent fibersinclude, but are not limited to: sheath/core arrangements; wherein onepolymer is surrounded by another; side-by-side arrangements; segmentedpie arrangements; or even “islands-in-the-sea” arrangements. Each of theaforementioned polymer arrangements is known in the art ofmulticomponent (including bicomponent) fibers.

Bicomponent fibers can be splittable fibers. Such fibers are capable ofbeing split lengthwise before or during processing into multiple fiberswith each of the multiple fibers having a smaller cross-sectionaldimension than that of the original bicomponent fiber. Splittable fibersmay provide softer fabrics due to their reduced cross-sectionaldimensions.

“Biconstituent fibers” as used herein, refers to fibers which have beenformed from at least two starting polymers extruded as a blend from thesame extruder. Biconstituent fibers may have the various polymercomponents arranged in relatively constantly positioned distinct zonesacross the cross-sectional area of the fiber, and the various polymersare usually not continuous along the entire length of the fiber. In thealternative, biconstituent fibers may comprise a blend, that may behomogeneous or otherwise, of the at least two starting polymers. Forexample, a bicomponent fiber may be formed from starting polymers whichdiffer only in molecular weight.

Biconstituent fibers may form fibrils, which may begin and end at randomalong the length of the fiber. Biconstituent fibers may sometimes bereferred to as multiconstituent fibers.

In illustrative examples of stretchable buttresses assemblies (100,110), planar fabrics that are useful to make stretchable buttressassemblies (100, 110) comprise fibers that are substantially aligned inone or more preferred directions, such as in the fabric's machinedirection, cross-machine direction, or combinations thereof. Usefulfabrics may be distinguished from fabric that comprises fibers in randomorientations, including but not limited to, melt blown, hydroentangled,and electrospun fabrics. The following provides several merelyillustrative examples of fiber arrangements that may be readilyincorporated into buttress assemblies (100, 110). It should therefore beunderstood that the following teachings may be readily combined with theteachings above. It should also be understood that some versions of thefollowing examples include a combination of elastic fibers andnon-elastic fibers.

In some surgical applications, it may be desirable to utilize buttressassemblies (100, 110) comprising buttress bodies (102, 112) that do notsubstantially stretch along the longitudinal axis (LA) of end effector(40) (along which the length of each buttress body (102, 112) runs); butthat do stretch laterally along the plane defined by each buttress body(102, 112). In other words, it may be desirable to provide buttressbodies (102, 112) that stretch along the dimension of the width ofbuttress bodies (102, 112). For example, a surgeon may wish to staple ananatomical structure that is not intended to stretch once fastened withan extensible staple line. However, the surgeon may not wish to stopmid-surgery and exchange instrument (10) and/or shaft assembly (730). Byapplying to the anatomical structure a buttress assembly (100, 110) thatdoes not substantially stretch along the longitudinal axis (LA) of endeffector (40), the stretch of the staple line may be minimized or eveneliminated. In an illustrative example, during a lobectomy, a surgeonmay wish to apply an extensible staple line to the lung parenchyma butapply a non-extensible staple line to the bronchus. In such settings,the surgeon may apply an extensible staple line without buttressassembly (100, 110) to the parenchyma; then apply an extensible stapleline with buttress assembly (100, 110) to the bronchus. The presence ofthe applied, non-longitudinally-extensible buttress assembly (100, 110)will essentially convert an otherwise extensible staple line into anon-extensible staple line as applied to the bronchus.

In some other surgical applications, it may be desirable to utilizebuttress assemblies (100, 110) comprising buttress bodies (102, 112)that do stretch along the longitudinal axis (LA) of end effector (40);but that do not substantially stretch laterally along the plane definedby each buttress body (102, 112). In other words, it may be desirable toprovide buttress bodies (102, 112) that stretch along the dimension ofthe length of buttress bodies (102, 112). Referring back to the exampleof a lung lobectomy, the lung may be in a collapsed state when thesurgeon actuates end effector (40) on the parenchyma of the lung. Whenthe lung is later reinflated, the resulting expansion of the lunch willapply tension in the parenchyma, thereby providing extension along thestaple line. An extensible staple line (e.g., as taught in U.S. patentapplication Ser. No. 14/498,145 and/or U.S. patent application Ser. No.14/498,070) may thus accommodate such extension. In settings where thesurgeon wishes for that staple line to be reinforced by a buttressassembly (100, 110), that buttress assembly (100, 110) may need to beextensible along the longitudinal axis in order to accommodate theexpansion of the lung during reinflation. Otherwise, a non-extensiblebuttress assembly (100, 110) may create stress at the staple line duringreinflation, possibly tearing tissue, compromising the integrity of thestaple line, resulting in leaks, and/or providing other adverse results.Thus, buttress bodies (102, 112) that substantially stretch along thelongitudinal axis (LA) of end effector (40) may be needed.

The following examples relate to various woven or knit configurationsthat may be provided in fabrics that are used to form buttress bodies(102, 112). In the following examples, such buttress bodies (102, 112)may be formed and oriented such that they provide a stretch axis that isparallel to the longitudinal axis (LA) of end effector (40) (i.e., suchthat buttress bodies (102, 112) provide a stretch axis that extendsalong the length of buttress bodies (102, 112)). Alternatively, suchbuttress bodies (102, 112) may be formed and oriented such that theyprovide a stretch axis that is perpendicular to the longitudinal axis(LA) of end effector (40) (i.e., such that buttress bodies (102, 112)provide a stretch axis that extends across the width of buttress bodies(102, 112)). As yet another alternative, buttress bodies (102, 112) maybe formed and oriented such that they provide a stretch axis that isotherwise oriented in relation to the longitudinal axis (LA) of endeffector (40).

In the present example, variations of buttress bodies (102, 112) areformed by a combination of elastic fibers and non-elastic fibers, all ofwhich are arranged in a repeatable pattern. The elastic fibers areoriented along the stretch axis and the non-elastic fibers are orientedtransversely relative to the stretch axis. It should be understood thatthe stretchability of elastic versions of buttress bodies (100, 110) maybe manipulated based upon the choice of fiber material, the orientationof the fibers, tension on the fibers during fabric production, andvarious other factors.

By way of example only, the planar fabric may comprise elastic, i.e.,extensible, fibers made from polymers selected from the group consistingof: poly(caprolactone)-co-poly(glycolide) (PCL/PGA);poly(caprolactone)-co-poly(lactide) (PCL/PLA);poly(lactide)-co-trimethylene carbonate (PCL/TMC); poly(p-dioxanone)(PDO); polyglactin 910 polymer mesh; and combinations thereof. Othersuitable materials that may be used to form elastic fibers will beapparent to those of ordinary skill in the art in view of the teachingsherein. Similarly, various suitable materials that may be used to formthe non-elastic fibers will be apparent to those of ordinary skill inthe art in view of the teachings herein. Non-elastic, i.e.non-extensible, fibers may be made from polymers selected from the groupconsisting of: poly(caprolactone)-co-poly(glycolide) (PCL/PGA);poly(caprolactone)-co-poly(lactide) (PCL/PLA);poly(lactide)-co-trimethylene carbonate (PCL/TMC); poly(p-dioxanone)(PDO); polyglactin 910 polymer mesh; polyglycolide (PGA) felt (forexample, Neoveil™ felt from Gunze Limited (Kyoto, Japan)); a microporousstructure of polyglycolic acid:trimethylcarbonate (PGA:TMC) (forexample, Gore® Seamguard® from W.L. Gore & Associates, Inc. (Newark,Del.)); and combinations thereof. It should also be understood that theelastic fibers and the non-elastic fibers may each comprisemultifilament fiber, monofilament fiber, or combinations thereof. Therelative geometries and constructions of different fibers may be used tochange the relative extensibility of the fibers.

In some versions, an elastic planar fabric that is used to form buttressbodies (102, 112) comprises woven fiber structures. Woven fiberstructures comprise crossed warp and weft fibers. The warp and weftfibers may be perpendicular to each other, such that they intersect atabout a 90° angle. The stretchability of woven fabrics may be morematerial dependent than pattern dependent. However, woven fabrics maycomprise less extensible structures compared to knits. Using anelastomeric yarn in the filling may improve the stretch and recovery ofthe woven fabrics, in which case, extensibility would likely occurmainly in the cross direction.

In some examples, woven fiber fabrics may preferably comprisemonocomponent fibers that are either multifilament or monofilament andof relatively fine denier with a low denier per filament (DPF). In someexamples, both multifilament and monofilament fibers may be used in thesame buttress construct. In some examples, two or more monocomponentfibers of different polymer composition may be used to achieve desiredbuttress body properties.

Useful planar fabrics may be woven in any pattern that provides forsubstantial stretchability in at least one direction (i.e., along astretch axis) and substantial recovery of the fabric's original shapeafter being stretched. By way of example only, the planar fabric may bewoven in a pattern selected from the group consisting of: twill weave;plain weave; satin weave; and combinations thereof. More particularly,the planar fabric may comprise more than one woven pattern; indeed,while the twill pattern, plain weave pattern, etc. comprise basicarrangements of warp and fill yarns (i.e. weft yarns), any number ofdesirable designs can be produced by altering the location and frequencyof interlacing.

FIG. 167 is a diagram depicting a weave pattern of an exemplary planarfabric (7200) that comprises fibers (7210, 7220) that have been wovensuch that the warp fibers (7210) and weft fibers (7220) intersect atangles of about 90°. In this example, warp fibers (7210) are formed of anon-elastic material while weft fibers (7220) are formed of an elasticmaterial. Warp fibers (7210) are arranged in parallel along the machinedirection (MD) and perpendicular to the cross-machine direction (CD) ofplanar fabric (7200). Warp fibers (7210) are also perpendicular to thestretch axis (SA). Weft fibers (7220) are inserted in the transversedirection, parallel to cross-machine direction (CD) of the planar fabric(7200) and perpendicular to the warp fibers (7210). Weft fibers (7220)are thus parallel to the stretch axis (SA). Thus, with respect to theplanar fabric (7200) machine direction (MD), warp fibers (7210) arelongitudinally oriented, whereas weft fibers (7220) are transverselyoriented. The weave pattern of elastic weft fibers (7220) is configuredto enable stretching of planar fabric (7200) along the stretch axis(SA). Planar fabric (7200) is thus extensible despite the fact thatplanar fabric (7200) includes non-elastic warp fibers (7210).

FIG. 168 shows an illustrative example of a buttress body (7250) thatcomprises the woven planar fabric (7200) of FIG. 167, wherein the planarfabric (7200) is oriented in such a way that the warp fibers (7210) andweft fibers (7220) intersect the stretch axis (SA) of the buttress body(7250) at an angle of about 45°. Buttress body (7250) is shown in a botha relaxed state (7250 a) and a stretched state (7250 b). In particular,buttress body (7250) is shown as being stretchable along stretch axis(SA). In some versions, the stretch axis (SA) is parallel to thelongitudinal axis (LA) of end effector (40). In some other versions, thestretch axis (SA) is perpendicular to the longitudinal axis (LA) of endeffector (40). In still other versions, the stretch axis (SA) has someother angular relationship with the longitudinal axis (LA) of endeffector (40). It should be understood that buttress body (7250) may besecured to end effector (40) and originally applied to tissue (T₁, T₂)while buttress body (7250) is in a relaxed, non-stretched state as isthe case with buttress body (7250 a). In other words, in the presentexample, buttress body (7250) only reaches the stretched state (7250 b)after buttress body (7250) has been secured to tissue (T₁, T₂) bystaples (90). Buttress body (7250) would reach the stretched state (7250b) to accommodate stretching of tissue (T₁, T₂). However, the stretchingof buttress body (7250) would not adversely impact the securing andsealing of tissue (T₁, T₂) provided by staples (90) and buttress body(7250).

It should be understood that planar fabric (7200) may be modified invarious ways. The performance of buttress body (7250) may neverthelessbe substantially the same despite variations in the configuration ofplanar fabric (7200). For instance, some other versions of planar fabric(7200) comprise a warp knit, weft-inserted fabric. For example, fibersmay be knitted in a Raschel weft-insertion pattern using any number ofsuitable needle beds and guide bars. In some illustrative embodiments,one or two needle beds and four to eight guide bars may be utilized.

FIG. 169 is a diagram depicting an exemplary planar fabric (7300) havinga Raschel weft-insertion pattern of fibers. Planar fabric (7300)comprises warp fibers (7310) that have been formed into columns ofpillars produced by interlooping the warp fibers (7310) to form a chainstitch, and by laying in weft fibers (7320) to connect the columns ofpillars together and form the fabric design. The resulting planar fabric(7300) may be substantially stable in both the machine direction (MD)and cross-machine direction (CD), unless the weft fibers (7320) areelastomeric, in which case, the resulting planar fabric (7300) willsubstantially stretch in the cross machine direction (CD). In otherwords, if the weft fibers (7320) are elastomeric, the stretch axis (SA)of the planar fabric (7300) may be perpendicular to its machinedirection (MD). In some versions, the planar fabric (7300) maysubstantially recover its original shape after it has been stretched.

In still other variations of the planar fabric (7300) depicted in FIG.169, a non-elastic fiber is wrapped around an elastic fiber to form acoil-like spring around a stretchable center. The resulting combinationof fibers may then be used as the weft fibers (7320) that are laid in toform the design and connect the columns of pillars of warp fibers (7310)together as shown in FIG. 169.

The foregoing examples include configurations where elastic fibers arecombined with non-elastic fibers to form planar fabric (7200) that isused to form buttress bodies (102, 112). As yet another merelyillustrative variation, planar fabric (7200) may be formed entirely ofnon-elastic fibers yet may still provide extensibility along a stretchaxis. For instance, planar fabric (7200) may comprise non-elastic fibersthat are pre-kinked (e.g., into the shape of a coil spring, zigzagpattern, or some other configuration) to reduce the effective length ofthe non-elastic fibers. When such non-elastic fibers are pulledlongitudinally, the kinks or bends in the non-elastic fibers mayaccommodate elongation of the effective length of the non-elasticfibers. Moreover, the kinked or otherwise bent non-elastic fibers mayprovide a resilient bias such that the non-elastic fibers are biased toprovide the shorter effective length.

In some versions of planar fabric (7200) that are formed entirely ofnon-elastic fibers, the non-elastic fibers may be provided as yarns thatare woven or knitted into a pre-existing fibrous structure. Forinstance, the kinked or otherwise bent non-elastic fibers may be wovenor knitted into a pre-existing, stretchable sheet of fabric. The kinkedor otherwise bent non-elastic fibers may impart a resilient bias to thepre-existing, stretchable sheet of fabric along the stretch axis (SA);yet may still enable the resulting assembly to be extensible along thestretch axis (SA).

Those of ordinary skill in the art will recognize that there are variousways in which non-elastic fibers may be pre-kinked, pre-bent, orotherwise manipulated to provide the properties described above. Forinstance, such non-elastic fibers may be texturized through airjetentanglement. Alternatively, non-elastic fibers may be mechanicallytexturized (e.g., using geared rollers, etc.). As yet another merelyillustrative example, the non-elastic fibers may be knitted into aknitted arrangement, then de-knitted from that arrangement. In some suchversions, the non-elastic fibers are knitted into a fabric and heat set.The heat set may impart the kinked or bent configuration to thenon-elastic fibers. After the heat set is performed, the fabric isunraveled, with the non-elastic fibers retaining a kinked or bentconfiguration due to the heat set. Still other suitable techniques thatmay be used to pre-kink, pre-bend, or otherwise manipulate non-elasticfibers to provide the properties described above will be apparent tothose of ordinary skill in the art in view of the teachings herein

XXVII. EXEMPLARY STRETCHABLE BUTTRESS ASSEMBLY FOR SURGICAL STAPLER

In some instances, it may be desirable to equip end effector (40) with abuttress assembly (100, 110) comprising an adhesive layer (104, 114) incombination with a buttress body (102, 112) that is constructed from anelastic material that is substantially stretchable in at least onedirection and that will substantially recover its original shape. Theresulting buttress assemblies (100, 110) may advantageously reinforcethe mechanical fastening of tissue provided by staples (890), whilemoving with, rather than restraining, the underlying tissue. Suchbuttress assemblies (100, 110) may be particularly useful inapplications in which the tissue that is fastened may subsequentlyexpand and/or contract. For example, stretchable buttress assemblies(100, 110) may be of use to reinforce the mechanical fastening of acollapsed lung that is then re-inflated, and expands and contracts withthe lung during the breathing process.

In illustrative examples of stretchable buttresses assemblies (100,110), the buttress bodies (102, 112) may comprise fibrous, planarfabric. “Fiber” as used herein means continuous fibers, which aresometimes referred to in the art as “substantially continuousfilaments,” “filaments,” or “yarn,” or staple fibers having an averagelength that is sufficient so that the staple fibers may be knittedand/or woven together. Fibers that are useful may be selected from thegroup consisting of: monocomponent fibers; multicomponent fibers;bicomponent fibers; biconstituent fibers; and combinations thereof.

“Monocomponent fiber” as used herein, refers to a fiber formed fromusing one or more extruders from only one polymer; this is not meant toexclude fibers formed from one polymer to which small amounts ofadditives have been added. Additives may be added to the polymer for thepurposes of providing the resulting fiber with coloration, antistaticproperties, lubrication, hydrophilicity, and/or other properties.Monocomponent fibers may be multifilament or monofilament fibers.

“Multicomponent fiber” as used herein, refers to a fiber formed from twoor more different polymers that are extruded from separate extruders andspun together to form one fiber.

“Bicomponent fibers” are one type of multicomponent fiber, and areformed from two different polymers. Bicomponent fibers may sometimes bereferred to in the art as “conjugate fibers.” Bicomponent fibers may becomprised of polymers that are substantially continuously positioned indistinct zones, both across the cross-section of the bicomponent fibersand along their length. Non-limiting examples of such bicomponent fibersinclude, but are not limited to: sheath/core arrangements, wherein onepolymer is surrounded by another; side-by-side arrangements; segmentedpie arrangements; or even “islands-in-the-sea” arrangements. Each of theaforementioned polymer arrangements is known in the art ofmulticomponent (including bicomponent) fibers.

Bicomponent fibers can be splittable fibers. Such fibers are capable ofbeing split lengthwise before or during processing into multiple fiberswith each of the multiple fibers having a smaller cross-sectionaldimension than that of the original bicomponent fiber. Splittable fibersmay provide softer fabrics due to their reduced cross-sectionaldimensions.

“Biconstituent fibers” as used herein, refers to fibers which have beenformed from at least two starting polymers extruded as a blend from thesame extruder. Biconstituent fibers may have the various polymercomponents arranged in relatively constantly positioned distinct zonesacross the cross-sectional area of the fiber, and the various polymersare usually not continuous along the entire length of the fiber. In thealternative, biconstituent fibers may comprise a blend, that may behomogeneous or otherwise, of the at least two starting polymers. Forexample, a bicomponent fiber may be formed from starting polymers whichdiffer only in molecular weight.

Biconstituent fibers may form fibrils, which may begin and end at randomalong the length of the fiber. Biconstituent fibers may sometimes bereferred to as multiconstituent fibers.

In illustrative examples of stretchable buttresses assemblies (100,110), planar fabrics that are useful to make stretchable buttressassemblies (100, 110) comprise fibers that are substantially aligned inone or more preferred directions, such as in the fabric's machinedirection, cross-machine direction, or combinations thereof. Usefulfabrics may be distinguished from fabric that comprises fibers in randomorientations, including but not limited to, melt blown, hydroentangled,and electrospun fabrics. The following provides several merelyillustrative examples of fiber arrangements that may be readilyincorporated into buttress assemblies (100, 110). It should therefore beunderstood that the following teachings may be readily combined with theteachings above.

A. Exemplary Stretchable Buttress Assemblies that do not SubstantiallyStretch Along the Longitudinal Axis of an End Effector

In some surgical applications, it may be desirable to utilize buttressassemblies (100, 110) comprising buttress bodies (102, 112) that do notsubstantially stretch along the longitudinal axis (LA) of end effector(40) (along which the length of each buttress body (102, 112) runs); butthat do stretch laterally along the plane defined by each buttress body(102, 112). In other words, it may be desirable to provide buttressbodies (102, 112) that stretch along the dimension of the width ofbuttress bodies (102, 112). For example, a surgeon may wish to staple ananatomical structure that is not intended to stretch once fastened withan extensible staple line. However, the surgeon may not wish to stopmid-surgery and exchange instrument (10) and/or shaft assembly (30). Byapplying to the anatomical structure a buttress assembly (100, 110) thatdoes not substantially stretch along the longitudinal axis (LA) of endeffector (40), the stretch of the staple line may be minimized or eveneliminated. In an illustrative example, during a lobectomy, a surgeonmay wish to apply an extensible staple line (e.g., as taught in U.S.patent application Ser. No. 14/498,145, entitled “Method for Creating aFlexible Staple Line,” filed Sep. 26, 2014, the disclosure of which isincorporated by reference herein; and/or U.S. patent application Ser.No. 14/498,070, entitled “Radically Expandable Staple Line,” filed Sep.26, 2014, the disclosure of which is incorporated by reference herein)to the lung parenchyma but apply a non-extensible staple line to thebronchus. In such settings, the surgeon may apply an extensible stapleline without buttress assembly (100, 110) to the parenchyma; then applyan extensible staple line with buttress assembly (100, 110) to thebronchus. The presence of the applied, non-longitudinally-extensiblebuttress assembly (100, 110) will essentially convert an otherwiseextensible staple line into a non-extensible staple line as applied tothe bronchus.

The following examples relate to various knit or woven configurationsthat may be provided in fabrics that are used to form buttress bodies(102, 112). In the following examples, such buttress assemblies (100,110) comprise buttress bodies (102, 112) formed by planar fabric that isconstructed from fibers that are substantially unaligned withlongitudinal axis (LA) of end effector (40).

1. Exemplary Buttress Assemblies Comprising Warp Knitted Planar Fabric

Planar fabric may comprise looped fiber structures that are obtainedthrough warp knitting. In addition to being substantially stretchable inone direction, warp knitted fabrics may tend not to unravel or curl,particularly as compared to weft knitted fabrics (discussed below). Insome versions, planar fabric that is warp knitted comprises fibers thatare delivered to the fabric knitting zone in parallel to each other andthe edge of the fabric. The edge of the fabric is created as a result ofthe fibers being delivered in the fabric machine direction (i.e., the“shog”) to form loops, the edge being formed by the fibers as they movelaterally. In addition to moving laterally across the machine direction,the fibers may move in front of and behind the fabric plane (i.e., the“swing”) or between multiple fabric planes (as in a spacer fabricconstruction) to connect stitches and form fabric loops.

In some examples, warp knitted planar fabric may preferably comprisemonocomponent fibers that are either multi-filament or mono-filament andof relatively fine denier with a low denier per filament (DPF). In someexamples, both multifilament and monofilament fibers may be used in thesame warp knit buttress body (102, 112). In some examples, two or moremonocomponent fibers of different polymer compositions may be used toachieve desired buttress body (102, 112) properties.

In some illustrative examples, the warp knitted fabric is warp knittedusing tricot and/or Raschel knitting machines using needle bed and guidebar configurations known to those skilled in the art, to provide a warpknitted fabric comprising one or more knitted patterns. When utilizingone or more of the aforementioned machines, the resulting warp knitfabric may be formed by a series of overlaps and underlaps which may bearranged in various combinations. In addition, or in the alternative,open and closed stitches may be formed as a result of the direction ofthe overlaps and underlaps. Useful lapping patterns include but are notlimited to: pillar lap, 1&1 lap (tricot lap), 2&1 lap, 3&1 lap, 4&1 lap,atlas lap and combinations thereof. Since some Raschel knitting machinescomprise a greater number of guide bars than tricot knitting machines,they may provide for a greater number of possible knitting patterns. Insome examples in which spacer fabrics are desired, a double needle barRaschel machine may be used such that a unique secondary knitted fabriclayer is being simultaneously produced and connected to a first fabriclayer.

FIG. 170 is a diagram depicting a knit pattern of an exemplary planarfabric (8750) that comprises fibers (8751) knitted in a tricot patternusing two guide bars, although up to four guide bars could be utilizedto increase the complexity of the tricot pattern. As can be seen in FIG.170, fibers (8751) zigzag along the cross-machine direction of thefabric to connect stitches and form fiber loops (8752). The resultingplanar fabric may be substantially stretchable in the cross-machinedirection of the fabric, but may not be substantially stretchable in themachine direction of the fabric. In some instances, after the resultingplanar fabric is stretched, it may substantially recover its originalshape.

Warp knitted planar fabric (8750, 8850) may be formed into buttressbodies (102, 112) such that the buttress bodies (102, 112) will notsubstantially stretch along longitudinal axis (LA) of end effector (40).However, such buttress bodies (102, 112) may nevertheless stretch indirections that are transverse to longitudinal axis (LA) of end effector(40) along the planes defined by buttress bodies (102, 112). Suchbuttress bodies (102, 112) may be useful when a surgeon wishes to staplean anatomical structure that will naturally stretch in directions thatare transverse to longitudinal axis of the staple line. It may also bebeneficial to permit stretching in directions that are transverse tolongitudinal axis of the staple line in cases where there is a series ofstaple lines arranged generally end-to-end, where the longitudinal axesof the staple lines are not perfectly aligned with each other.

2. Exemplary Buttress Assemblies Comprising Weft Knitted Planar Fabric

Planar fabric may comprise looped fiber structures that are obtainedthrough weft knitting. As compared to warp knitted fabrics, weft knittedfabrics may by characterized by greater stretch and recoverability, andmay also be made utilizing fewer fiber spools, even a single fiberspool. In some versions, planar fabric that is weft knitted comprisesfibers that are delivered to the fabric knitting zone in a horizontal,cross-machine and circular direction. In some versions, the weft knittedfabric is knitted in a ribbed pattern.

In some examples, weft knitted planar fabric may preferably comprisemonocomponent fibers that are either multifilament or monofilament andof relatively fine average denier with a low average denier per filament(DPF). In some examples, both multifilament and monofilament fibers maybe used in the same warp knit buttress body (102, 112) construct. Insome examples, two or more monocomponent fibers of different polymercomposition may be used to achieve desired buttress body (102, 112)properties.

FIG. 171 is a diagram depicting an exemplary weft knit planar fabric(8850) that comprises fibers (8851) knitted in a weft-insertion patternusing a Raschel knitting machine. As can be seen in FIG. 171, the fibers(8851) zigzag along the cross-machine direction of the fabric to connectstitches and form fiber loops (8852). The resulting planar fabric (8850)may be substantially stretchable in the cross-machine direction of thefabric, but may not be substantially stretchable in the machinedirection of the fabric. In some instances, after the resulting planarfabric is stretched, it may substantially recover its original shape.

FIG. 172 is a diagram depicting a knit pattern of another exemplaryplanar fabric (8950) that comprises fibers (8951) knitted in a weftpattern. As can be seen in FIG. 172, each fiber loop (8952) is formedfrom the previous fiber loop (8952). The resulting planar fabric (8950)may be characterized by stretchability in the cross-machine direction ofthe fabric and good recoverability of its original shape.

Weft knitted planar fabrics (8950) may be formed into buttress bodies(102, 112) such that the buttress bodies (102, 112) will notsubstantially stretch along longitudinal axis (LA) of end effector (40).However, such buttress bodies (102, 112) may nevertheless stretch indirections that are transverse to longitudinal axis (LA) of end effector(40) along the planes defined by buttress bodies (102, 112). Suchbuttress bodies (102, 112) may be useful when a surgeon wishes to staplean anatomical structure that will naturally stretch in directions thatare transverse to longitudinal axis of the staple line. It may also bebeneficial to permit stretching in directions that are transverse tolongitudinal axis of the staple line in cases where there is a series ofstaple lines arranged generally end-to-end, where the longitudinal axesof the staple lines are not perfectly aligned with each other.

3. Exemplary Buttress Assemblies Comprising Woven Planar Fabric

Planar fabric may comprise woven fiber structures. Woven fiberstructures comprise crossed warp and weft fibers. The warp and weftfibers are perpendicular to each other, such that they intersect atabout a 90° angle.

In some examples, woven fiber structures may preferably comprisemonocomponent fibers that are either multifilament or monofilament andof relatively fine denier with a low denier per filament (DPF). In someexamples, both multifilament and monofilament fibers may be used in thesame warp knit buttress body (102, 112) construct. In some examples, twoor more monocomponent fibers of different polymer composition may beused to achieve desired buttress body (102, 112) properties.

Useful planar fabrics may be woven in any pattern that provides forsubstantial stretchability in at least one direction and substantialrecovery of the fabric's original shape after being stretched. By way ofexample only, the planar fabric may be woven in a pattern selected fromthe group consisting of: twill weave; plain weave; and combinationsthereof. In further examples, planar fabric may comprise more than onewoven pattern, indeed while the twill pattern, plain weave pattern, etc.comprise basic arrangements of warp and fill yarns, any number ofdesirable designs can be produced by altering the location and frequencyof interlacing.

FIG. 173 is a diagram depicting an exemplary planar fabric (81050)having a Raschel weft-insertion pattern of fibers. Planar fabric (81050)comprises warp fibers (81051 a) that have been formed into columns ofpillars produced by interlooping the warp fibers (81051 a) to form achain stitch, and by laying in weft fibers (81051 b) to connect thecolumns of pillars together and form the fabric design. The resultingplanar fabric (81050) may be substantially stable in both the machinedirection (MD) and cross-machine direction (CD), unless the weft fibers(81051 b) are elastomeric, in which case, the resulting planar fabric(81050) will substantially stretch in the cross machine direction (CD).In other words, if the weft fibers (81051 b) are elastomeric, thestretch axis (SA) of the planar fabric (81050) may be perpendicular toits machine direction (MD). In some versions, the planar fabric (81050)may substantially recover its original shape after it has beenstretched. In still other variations of the planar fabric (81050)depicted in FIG. 173, a non-elastic fiber is wrapped around an elasticfiber to form a coil-like spring around a stretchable center. Theresulting combination of fibers may then be used as the weft fibers(81051 b) that are laid in to form the design and connect the columns ofpillars of warp fibers (81051 a) together as shown in FIG. 173.

An illustrative example of the stretchability of woven planar fabric isdepicted in FIG. 174. In particular, a woven planar fabric (81150)comprises warp fibers (81151 a) and weft fibers (81151 b) that intersectat angles of about 90°. The woven planar fabric (81150) is oriented insuch a way that the longitudinal axis of the fabric (81150) is at aboutan angle of 45° relative to the warp fibers (81151 a) and weft fibers(81151 b). When the planar fabric is in its unstretched or relaxed state(81150 a), the warp fibers and weft fibers intersect at a first angle,A₁, and the fabric is characterized by a first width, W₁, and firstlength, L₁. When the planar fabric is in its stretched state (81150 b),the warp fibers and weft fibers intersect at a second angle, A₂, whichis greater than A₁, but which is still not equal to 90°. In addition,when the planar fabric is in its stretched state (81150 b), it isfurther characterized by a width, W₂, that is greater than W₁, and alength, L₂ that is greater than L₁. When forces that cause the planarfabric to be in its stretched state (81150 b) are removed, the planarfabric may substantially return to its relaxed state (81150 a), or to astate that is somewhere in between the stretched state (81150 a) and therelaxed state (81150 b).

Woven planar fabric (81050, 81150) may be formed into a buttress body(102, 112) such that the planar fabric that does not substantiallystretch along longitudinal axis (LA) of end effector (40). However, suchbuttress bodies (102, 112) may nevertheless stretch in directions thatare transverse to longitudinal axis (LA) of end effector (40) along theplanes defined by buttress bodies (102, 112). Such buttress bodies (102,112) may be useful when a surgeon wishes to staple an anatomicalstructure that will naturally stretch in directions that are transverseto longitudinal axis of the staple line. It may also be beneficial topermit stretching in directions that are transverse to longitudinal axisof the staple line in cases where there is a series of staple linesarranged generally end-to-end, where the longitudinal axes of the staplelines are not perfectly aligned with each other.

An illustrative example of a buttress body (81202) that comprises thewoven planar fabric (81150) of FIG. 174 is shown in FIG. 175. Thebuttress body (81202) is shown in a both a relaxed state (81202 a) and astretched state (81202 b).

B. Exemplary Stretchable Buttress Assemblies that Substantially StretchAlong the Longitudinal Axis of an End Effector

In some other surgical applications, it may be desirable to utilizebuttress assemblies (100, 110) comprising buttress bodies (102, 112)that do stretch along the longitudinal axis (LA) of end effector (40);but that do not substantially stretch laterally along the plane definedby each buttress body (102, 112). In other words, it may be desirable toprovide buttress bodies (102, 112) that stretch along the dimension ofthe length of buttress bodies (102, 112). Referring back to the exampleof a lung lobectomy, the lung may be in a collapsed state when thesurgeon actuates end effector (40) on the parenchyma of the lung. Whenthe lung is later reinflated, the resulting expansion of the lunch willapply tension in the parenchyma, thereby providing extension along thestaple line. An extensible staple line (e.g., as taught in U.S. patentapplication Ser. No. 14/498,145, entitled “Method for Creating aFlexible Staple Line,” filed Sep. 26, 2014, the disclosure of which isincorporated by reference herein; and/or U.S. patent application Ser.No. 14/498,070, entitled “Radically Expandable Staple Line,” filed Sep.26, 2014, the disclosure of which is incorporated by reference herein)may thus accommodate such extension. In settings where the surgeonwishes for that staple line to be reinforced by a buttress assembly(100, 110), that buttress assembly (100, 110) may need to be extensiblealong the longitudinal axis in order to accommodate the expansion of thelung during reinflation. Otherwise, a non-extensible buttress assembly(100, 110) may create stress at the staple line during reinflation,possibly tearing tissue, compromising the integrity of the staple line,resulting in leaks, and/or providing other adverse results. Thus,buttress bodies (102, 112) that substantially stretch along thelongitudinal axis (LA) of end effector (40) may be needed.

In some versions, the stretchability of the buttress bodies (100, 110)may be manipulated based upon the choice of fiber material, theorientation of the fibers, tension on the fibers during fabricproduction, and combinations thereof. Orientation of the fibers mayrefer to the way that warp fibers are threaded through the needles(called the threading pattern—each guide bar can be fully threaded orpartially threaded), which can affect the density of the fabric andtherefore its extensibility. In warp and weft knit constructs,elasticity or “stretchability” of the fabric may be impacted by thetension on both the fiber systems and the fabric (being taken up onto aroll after knitting) during the fabric forming process. Tension mayimpact the size of the loops that are formed. Slight adjustments intension and the resulting impact on fiber loop size may allow for moreextensibility and recovery.

Elastic fibers may be utilized in the construction of the planar fabric.By way of example only, the planar fabric may comprise elastic fibersmade from copolymers selected from the group consisting of:poly(caprolactone)-co-poly(glycolide) (PCL/PGA);poly(caprolactone)-co-poly(lactide) (PCL/PLA);poly(lactide)-co-trimethylene carbonate (PCL/TMC); and combinationsthereof.

In some examples, the elastic fibers comprising either multifilament ormonofilament fibers (depending on the degree of fabric stiffness,strength and elongation that is desired) may be utilized. In someexamples, the elastic fibers are bicomponent fibers comprisingnon-elastic fibers that are wrapped around elastic fibers to form acoil-like spring around a stretchable center. Planar fabric comprisingelastic fibers may be formed into a buttress body (102, 112) such thatthe planar fabric that substantially stretches along the longitudinalaxis (LA) of end effector (40).

XXVIII. EXEMPLARY MULTI-LAYER ADHESIVE ARRANGEMENT FOR BUTTRESS ASSEMBLY

In some instances, it may be desirable to provide a version of abuttress assembly (100, 110) where adhesive layer (104, 114) comprisestwo or more layers of different kinds of adhesive material havingdifferent properties. For instance, FIGS. 176-177 show an exemplarybuttress assembly (9200) that comprises a buttress body (9202), a firstadhesive layer (9204) laid over buttress body (9202), and a secondadhesive layer (9206) laid over first adhesive layer (9204). It shouldbe understood that, with buttress body (9202) at the bottom of buttressassembly (9200), buttress assembly (9200) is analogous to buttressassembly (100) described above and may be similarly secured to underside(65) of anvil (60). Alternatively, buttress assembly (9200) may beflipped upside-down for an arrangement where buttress assembly (9200)would be secured to deck (73) of staple cartridge (70). In suchversions, second adhesive layer (9206) would be at the bottom, firstadhesive layer (9204) would be laid over second adhesive layer (9206),and buttress body (9202) would be laid over first adhesive layer (9204).

Buttress body (9202) may be constructed and operable just like buttressbodies (102, 112) described above. Moreover, buttress body (9202) may beconstructed and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,92015, the disclosure of which is incorporated by reference herein.Other suitable forms that buttress body (9202) may take will be apparentto those of ordinary skill in the art in view of the teachings herein.

First adhesive layer (9204) is formed of an adhesive material that isdifferent from the adhesive material forming second adhesive layer(9206). In some versions, first adhesive layer (9204) is formed of amaterial that has greater pliability and tackiness than the materialforming second adhesive layer (9206). In some such versions, secondadhesive layer (9206) serves as a protectant for first adhesive layer(9204). For instance, second adhesive layer (9206) may protect firstadhesive layer (9204) from humidity, temperature fluctuations, and/orother environmental conditions that may be encountered during shipmentand/or storage of buttress assembly (9200). In other words, secondadhesive layer (9206) may be more resistant to moisture and/ortemperature than first adhesive layer (9206). In some other variations,second adhesive layer (9206) is replaced with a non-adhesive protectivelayer. By way of example only, second adhesive layer (9206) may bereplaced by a film or other structure that is biocompatible andbioabsorbable, dissolvable, or otherwise capable of temporarilyconfining the material forming first adhesive layer (9204) (e.g., toprevent first adhesive layer from seeping, migrating, or otherwiseflowing out of buttress assembly (9200) during storage, shipping,handling before surgery, etc.). When anvil (60) is pressed againstbuttress assembly (9200) both adhesive layers (9204, 9206) maynevertheless cooperate to adhere buttress assembly (9200) to underside(65) of anvil (60).

In some versions, second adhesive layer (9206) is sprayed onto firstadhesive layer (9204) while first adhesive layer is maintained at atemperature and humidity level that keeps first adhesive layer (9204)solid. It should be understood that the combination of differentadhesive layers (9204, 9206) may be more soluble against anvil (60)and/or less sticky against anvil (60) than just a single adhesive layer(9204) might be. This may prevent an undesirable buildup of adhesivematerial on underside (65) of anvil (60) as a series of buttressassemblies (9200) are applied to underside (65) for a series of endeffector (40) actuations during a surgical procedure. It should also beunderstood that adhesive layers (9204, 9206) may provide differentratios of two molecular weight blends in different layers (9204, 9206).In addition, adhesive layers (9204, 9206) may have cross-linkingdifferences and/or come from different families of adhesive. By way offurther example only, adhesive layers (9204, 9206) formed by highermolecular weight poloxamers may be stiffer and less prone to flow withtemperature. Thus, using a poloxamer blend with higher molecular weightto form adhesive layer (9206) may contain a lower molecular weightmaterial forming adhesive layer (9204), even if adhesive layer (9204)becomes fluid with temperature. Materials with higher degrees ofcross-linking may have higher transition temperatures and therefore flowless at temperature extremes. An example of different families could bea poloxamer blend in adhesive layer (9204) with a thin layer of PCL/PGAco-polymer sprayed onto adhesive layer (9204) to form adhesive layer(9206).

Various suitable materials that may be used to form second adhesivelayer (9206) and non-adhesive substitutes for second adhesive layer willbe apparent to those of ordinary skill in the art in view of theteachings herein. By way of example only, first adhesive layer (9204)may be configured and operable in accordance with at least some of theteachings of U.S. patent application No. [ATTORNEY DOCKET NO.END7809USNP.0630312], entitled “Surgical Stapler Buttress Assembly withHumidity Tolerant Adhesive,” filed on even date herewith, the disclosureof which is incorporated by reference herein; U.S. patent application.No. [ATTORNEY DOCKET NO. END7810USNP.0630307], entitled “SurgicalStapler Buttress Assembly with Adhesion to Wet End Effector,” filed oneven date herewith, the disclosure of which is incorporated by referenceherein; and/or any other references cited herein.

In buttress assembly (9200), the outer edges of first adhesive layer(9204) are left exposed by second adhesive layer (9206). FIGS. 178-179show an exemplary alternative buttress assembly (9300) where the outeredges of a first adhesive layer (9304) are covered by downwardlyprojecting regions (9308) of a second adhesive layer (9306). Downwardlyprojecting regions (9308) extend along the full width and the fulllength of first adhesive layer (9304) in this example. Downwardlyprojecting regions (9308) also extend downwardly into contact with theupper surface of buttress body (9302). Buttress body (9302) and secondadhesive layer (9306) thus cooperate to completely encapsulate firstadhesive layer (9304). Buttress body (9302), first adhesive layer(9304), and second adhesive layer (9306) may be otherwise identical tobuttress body (9202), first adhesive layer (9204), and second adhesivelayer (9206) as described above. Other suitable ways in which adhesivelayers (9304, 9306) may be configured and arranged in relation to abuttress body (9302) will be apparent to those of ordinary skill in theart in view of the teachings herein.

XXIX. EXEMPLARY HUMIDITY TOLERANT ADHESIVE MATERIALS AND TECHNIQUES FORPROVIDING ADHESION OF BUTTRESS TO MOIST SURGICAL STAPLER AND/OR MOISTTissue

In some surgical applications, it may be desirable to provide a buttressbody (102, 112) with one or more adhesive materials (104, 114) that willmaintain adhesive properties in a humid (i.e., moist or wet)environment, when buttress body (102, 112) is used intraoperatively, fora sufficient amount of time to complete the surgical procedure. Suchhumidity tolerant adhesive materials may provide for temporaryattachment of a buttress body (102, 112) to a wet jaw (50) or wet anvil(60) of the end effector (40) of a surgical stapling instrument (10),serve as an adjunct to reinforce the mechanical fastening of moisttissue (T₁, T₂) that is provided by staples (90), and combinationsthereof. Such humidity tolerant adhesives may ultimately degrade and beabsorbed by the body.

In some instances, the one or more adhesive materials (104, 114) have ahumidity tolerance that is defined as the ability to maintain thetemporary attachment of a buttress body (102, 112) to a jaw (50) oranvil (60) of an end effector (40) for at least ten minutes in anenvironment having 100% humidity (e.g., inside a patient) after buttressassembly (100, 110) has previously been exposed to a relative humidityof from 20% to 60% for a period up to sixty minutes at a temperature offrom about 15° C. to about 25° C.

By way of example, FIG. 180 shows an exemplary buttress assembly (10200)that may be used in place of buttress assembly (100) described above.Buttress assembly (10200) of this example comprises an upper buttressbody (10202) with a lower adhesive layer (10214). Buttress assembly(10200) of this example further comprises a lower buttress body (10212)with an upper adhesive layer (10204). In use, the lower and upperadhesive layers (10214, 10204) temporarily adhere to wet tissue (T₁, T₂)to serve as an adjunct to reinforce the mechanical fastening of thetissue provided by staples (90) as shown in FIG. 181. Of course, theapplied staples (90) will also secure buttress assembly (10200) totissue (T₁, T₂). Before buttress assembly (10200) is applied to tissue(T₁, T₂), buttress assembly (10200) may be removably secured to endeffector (40) in any suitable fashion as will be apparent to those ofordinary skill in the art in view of the teachings herein.

FIG. 182 shows another exemplary buttress assembly (10300) that may beused in place of buttress assembly (100) described above. Buttressassembly (10300) of this example comprises an upper buttress body(10302) that has an upper adhesive layer (10304 a) and a lower adhesivelayer (10314 a). Buttress assembly (10300) further comprises a lowerbuttress body (10312) having an upper adhesive layer (10304 b) and alower adhesive layer (10314 b). In use, upper and lower adhesive layers(10304 a, 10314 b) respectively provide for temporary attachment of thebuttress bodies (10302, 10312) to underside (65) of anvil (60) and deck(73) of staple cartridge (70). Lower and upper adhesive layers (10314 a,10304 b) temporarily adhere to tissue (T₁, T₂) to serve as an adjunct toreinforce the mechanical fastening of wet tissue provided by staples(90). Of course, the applied staples (90) will also secure buttressassembly (10300) to tissue (T₁, T₂).

In some instances, the humidity tolerant adhesive materials (e.g., oneor more of layers (104, 10204, 10304, 114, 10214, 10314)) for a buttressbody (102, 10202, 10302, 112, 10212, 10312) comprise bioabsorbablepolymers. Various physiomechanical properties of polymers may bemodified in order to provide different adhesive properties. Suchvariable characteristics include but are not limited to copolymercomposition, polymer architecture (e.g., random vs. block copolymersand/or branching), glass transition temperature (Tg), molecular weight(number average or weight average), inherent viscosity (IV),crystallinity, sequence distribution, copolymer chain composition,melting temperature (Tm), surface tension and rheological properties.Several exemplary combinations of these variables will be providedbelow, though it should be understood that these examples are merelyillustrative. It should also be understood that these examples ofadhesive materials may be provided in upper adhesive layer (104, 10204,10304). In addition or in the alternative, these examples of adhesivematerials may be provided in lower adhesive layer (114, 10214, 10314).In addition or in the alternative, these examples of adhesive materialsmay be otherwise integrated into buttress body (102, 10202, 10302, 112,10212, 10312). It should therefore be understood that the adhesivematerial need not necessarily constitute a separate layer that isdiscretely identifiable as being different from a layer defined bybuttress body (102, 10202, 10302, 112, 10212, 10312).

One of the aforementioned physiomechanical properties of polymers isglass transition temperature (Tg). Glass transition temperature (Tg) isthe temperature at which the mechanical properties of a copolymer changedramatically from a flowable adhesive to a brittle plastic. It may thusbe of importance that the glass transition temperature (Tg) issufficiently below the operating temperature of the adhesive in order toallow for polymer chain mobility. The glass transition temperature (Tg)is lower than the melting point of the crystalline form of the samecopolymer. The glass transition temperature (Tg) may be indicative ofhow the polymer behaves under ambient conditions. The glass transitiontemperature (Tg) can be effected by composition, polymer chainconfiguration and stiffness, molecular weight, viscosity, shear modulus,heat capacity, thermal expansion, cross-linking and other factors. It istherefore possible to have a relatively low glass transition temperature(Tg) material composition that does not always correspond to lowmolecular weight or low inherent viscosity (IV).

The melting temperature of a polymer may be referred to as the“first-order transition,” which is where the polymer changes from asolid to liquid. Crystalline polymers have a true melting point, whichis the temperature at which the crystallites melt and the total mass ofplastic becomes amorphous. Amorphous polymers do not have a true meltingpoint, but they do have a first-order transition wherein theirmechanical behavior transitions from a rubbery nature to viscous rubberyflow. Suitable polymers for use in forming adhesive layers (104, 10204,10304, 114, 10214, 10314) may have a percentage of crystallinity makingthem semi-crystalline, thus having both amorphous and crystallinedomains. The melting point of the polymer may be sufficiently high abovethe operating temperature of the adhesive to maintain cohesive strengthand provide dimensional stability of the applied adhesive.

Inherent viscosity (IV) reflects a measurement of molecular size. It isbased on the flow time of a polymer solution through small capillarychannels over time. The inherent viscosity (IV) and molecular weight ofa polymer are related, but that relational agreement is different foreach copolymer composition. For instance, the correlation of inherentviscosity (IV) to molecular weight may be logarithmic with only a smallmidsection of the curve being linear. This logarithmic correlation maydiffer as the copolymer composition differs. It is not necessarilyrequired to have a low molecular weight copolymer in order to manifestadhesive and malleable properties. Low molecular weight copolymers mayalso have shortened degradation cycles and reduced structural strength.The ideal adhesion film or adhesive substrate to use in adhesive layers(104, 10204, 10304, 114, 10214, 10314) may have higher molecular weightand low inherent viscosity (IV) to be both strong and adhesive. This maybe achieved, for example, by the introduction of polymer branching. Themolecular weight of the adhesive may need to be high enough to providemechanical strength to the adhesive to avoid cohesive failure, but alsosufficiently low enough that it can be cleared from the body throughdegradation in an acceptable amount of time.

Further important properties of the polymers include their surfacetension and rheological properties. If there is a sufficiently largemismatch between the surface tension of the adhesive and the surfaces tobe adhered to, adhesion may be energetically unfavorable. Similarly, therheological properties of the polymer such as bulk moduli may need to besuch that the polymer can flow to conform to the surface topography ofdeck (73) or underside (65), while simultaneously providing enoughintegrity to maintain cohesive strength and to resist shearing offand/or peeling off of end effector (40).

In some instances, the humidity tolerant adhesive materials may bemalleable. Malleable humidity tolerant adhesives may be highly viscousyet flowable at room temperature. A malleable humidity tolerant adhesivemay, in response to pressure being applied to it, take the form of asurface with which it is engaged. In other words, if a malleablehumidity tolerant adhesive is pressed against deck (73) of staplecartridge (70), the adhesive may take the form of the one or morefeatures of the deck (73) that it the adhesive is pressed against.Similarly, if a malleable humidity tolerant polymer adhesive is pressedagainst underside (65) of anvil (60), the adhesive may take the form ofthe one or more features of underside (65) that the adhesive is pressedagainst. By deforming to the geometry that it is pressed against, themalleable humidity tolerant adhesive may adhere to the geometry, and mayfurther provide re-applicable attachment. If the desired positioning ofbuttress assembly (100, 110) on deck (73) or underside (65) is notachieved, the malleable humidity tolerant adhesive may permit buttressassembly (100, 110) to be removed, repositioned, and re-adhered to deck(73) or underside (65). It should be understood that the humiditytolerant adhesives may be malleable at room temperature, such thatadditional heating or other treatment is not necessary in order toprovide malleability.

Providing the humidity tolerant adhesive material in the form of amalleable polymer may minimize the impact of fluids and debris on theadhesion of buttress assembly (100, 110) to deck (73) of staplecartridge (70) or underside (65) of anvil (60). The malleable humiditytolerant adhesive material may also be hydrophilic (e.g., at least incertain regions of buttress assembly (100, 110)), encouraging adhesionin a wet environment. In addition or in the alternative, adhesive layer(104, 114) of buttress assembly (100) may include a combination ofadhesive material and hydrophobic material in respective localizedregions. The hydrophobic material may drive fluids out of the adhesionareas, thereby improving adhesion at the localized regions of adhesivematerial. In some examples, the humidity tolerant adhesive material maybe combined with a buttress body (102,112) as disclosed in U.S. patentapplication Ser. No. 14/667,842, entitled “Method of Applying a Buttressto a Surgical Stapler,” filed Mar. 25, 102015, the disclosure of whichis incorporated by reference herein.

In some instances, the humidity tolerant adhesive materials may beextrudable. The extrudable adhesive may be extruded through a die thatmay be positioned directly next to or adjacent to the extruder. A meltpump may be used between the die and extruder. The die may be used toform an extrudate that is generally planar and continuous or to formdiscrete deposits (e.g., rod-shaped deposits) on the surface of abuttress assembly (100, 110) before it is pressed against a deck (73) ofstaple cartridge (70) or pressed against the underside of an anvil (60).

A. Exemplary Humidity Tolerant Adhesives with A-B-A Block PolymerConfigurations

In some instances, the humidity tolerant adhesive materials (e.g., oneor more of layers (104, 10204, 10304, 114, 10214, 10314)) for a buttressbody (102, 10202, 10302, 112, 10212, 10312) comprise polymers having ageneral A-B-A block configuration. In illustrative examples, the A-B-Ablock polymers comprise by the percentage of their molecular weight:from about 1% to about 50%, or more particularly from about 5% to about30% of A polymer blocks; and from about 50% to about 99%, or moreparticularly from about 70% to about 95%, of B polymer blocks.

The A polymer blocks are biodegradable, bioabsorbable, highlycrystalline segments, which are homopolymers that may be characterizedby a relatively high glass transition temperature (Tg) and/or arelatively high crystallinity. In illustrative examples, the Ahomopolymers may be characterized by a glass transition temperature (Tg)of at least about 0° C., preferably at least about 21° C. (i.e., roomtemperature). In addition, or in the alternative, the A homopolymers maybe characterized by a crystallinity as measured by X-ray diffraction ofat least about 30%, preferably at least about 40%, or more preferably atleast about 45%. In addition, or in the alternative, the A homopolymersmay have a molecular weight of at least about 5 kDa. Such exemplary Ahomopolymers may further be characterized by a melting temperature (Tm)of at least about 50° C., preferably at least about 60° C., and morepreferably at least about 70° C.

Exemplary A homopolymers may be selected from the group of:poly(L-lactide) (PLLA); poly(caprolactone) (PCL); polyglycolide (PGA);poly(103-hydroxybutyrate) (PH₃B); poly(103-hydroxyvalerate) (PHV); andpoly(p-dioxanone) (PPDO). It may be difficult to synthesize 100% Ahomopolymers. In some instances, the A homopolymers may contain a smallpercentage of residual B monomers. For example, exemplary A homopolymersmay contain a small percentage (e.g., up to about 10% by weight) of Bmonomers.

The B polymer blocks are biodegradable, bioabsorbable homopolymers orco-polymers, which are predominantly amorphous and may be characterizedby a relatively low to moderate glass transition temperature (Tg). Inillustrative examples, the B polymers as homopolymers or co-polymers maybe characterized by glass transition temperature (Tg) of at least about−40° C., more particularly at least about −30° C., and more particularlyat least about −20° C. In addition, or in the alternative, the Bhomopolymers or co-polymers may be characterized by a crystallinity asmeasured by X-ray diffraction of at most about 25%, more particularly atmost about 10%, or more particularly at most about 5%. In addition, orin the alternative, the B polymers as homopolymers or co-polymers mayhave a molecular weight of from about 20 to about 80 kDa, moreparticularly from about 30 to about 70 kDa, and more particularly, fromabout 40 to about 65 kDa.

Exemplary B homopolymers or co-polymers comprise monomers selected fromthe group consisting of: caprolactone (CL), L-Lactide (LLA), D,L-Lactide((D,L)LA), Glycolide (GA), Polydioxanone (PDO), Trimethylene carbonate(TMC), sebacic acid (SA), 1,6-bis(carboxyphenoxy)hexane (CPH), andcombinations thereof.

In some instances, the humidity tolerant adhesive materials having ageneral A-B-A block configuration may be blended with a tackifying agentto provide for an extrudable adhesive. Such extrudable humidity tolerantadhesive materials may be manufactured using hot melt extrusion. Inillustrative examples, the A-B-A block polymer may be fed into a hotmelt compounding twin-screw extruder. Once the A-B-A block polymer issufficiently masticated and melted, the tackifying agent is added intothe extruder. In some versions, additional compounds may be added in oneor more additional steps to the extruder. Such additional compounds mayselected from the group consisting of: plasticizing molecules;preservatives (e.g. antioxidants); fillers; and combinations thereof.Once mixing in the extruder is completed, the resulting adhesive may befed through an extruder die and produced as a stand-alone flexible filmthat is then applied to a buttress body (102, 112). In addition, or inthe alternative, the resulting adhesive may be fed through an extruderdie and deposited directly onto a buttress body (102, 112). In any case,the adhesive may then be annealed to obtain any necessary phaseseparation at, near or above the A-block melting temperature, T_(m). Inaddition, or in the alternative, the resulting adhesive may besterilized, such as by treating it with ethylene oxide at a hightemperature.

In illustrative examples, the tackifying agent may comprise asubstantially amorphous biodegradable, bioabsorbable polymer with amolecular weight below the entanglement molecular weight. In addition,or alternative, the tackifying agent may have a glass transition aboveabout 0° C., more particularly above about 20° C. In some examples, thetackifying agent may comprise a random copolymer ofpoly(L-lactide)-co-polyglycolide (PLGA) having a molecular weight offrom about 1 to about 8 kDA, more particularly from about 1.5 to about 5kDa.

In illustrative examples, an extrudable hot melt adhesive comprisesratios of polymer A-B-A and tackifying agent such that the glasstransition of the blend ranges from about −5° C. to about 15° C., moreparticularly from 0° C. to about 10° C. In addition, or in thealternative, the rheological properties of the polymer such as bulkmoduli need to be such that the polymer can flow to conform to thesurface topography of deck (73) or underside (65), while at the sametime, providing enough integrity to maintain cohesive strength andresisting shearing off and/or peeling off of end effector (40).

B. Exemplary Humidity Tolerant Adhesives with A-B-C Block TerpolymerConfigurations

In some instances, the humidity tolerant adhesive materials (e.g., oneor more of layers (104, 10204, 10304, 114, 10214, 10314)) for a buttressbody (102, 10202, 10302, 112, 10212, 10312) comprise polymers having ageneral A-B-C block terpolymer configuration, in which the C polymerblock comprises a hydrophilic polymer. Generally it is theorized, but inno way limits the scope of this invention, that humidity tolerantadhesives comprising hydrophilic polymers may have better wet surfaceretention characteristics than adhesives comprising only hydrophobicpolymers.

In some versions, the A-B-C block terpolymers may be combined with awater sorbent. Useful water sorbents may be selected from the groupconsisting of: carboxymethyl cellulose (CMC); polyvinylpyrrolidine(PVP); gelatin; hyaluronan; and combinations thereof. In some suchexamples, the A-B-C block terpolymers may be combined with water sorbentsuch that the resulting mixture comprises by its weight percentage fromabout 1% to about 60%, preferably from about 20% to about 40%, of thewater sorb ent.

The A polymer blocks are biodegradable, bioabsorbable, non-elastic,highly crystalline segments, which are homopolymers that may becharacterized by a relatively high glass transition temperature (Tg)and/or a relatively high crystallinity. In illustrative examples, the Ahomopolymers may be characterized by a glass transition temperature (Tg)of at least about 0° C., more particularly at least about 21° C. (i.e.,room temperature). In addition, or in the alternative, the Ahomopolymers may be characterized by a crystallinity as measured byX-ray diffraction of at least about 30%, more particularly at leastabout 40%, or more particularly at least about 45%. In addition, or inthe alternative, the A homopolymers may have a molecular weight of atleast about 5 kDa. Such exemplary A homopolymers may further becharacterized by a melting temperature (Tm) of at least about 50° C.,more particularly at least about 60° C., and more particularly at leastabout 70° C.

Exemplary A homopolymers may be selected from the group of:poly(L-lactide) (PLLA); poly(caprolactone) (PCL); polyglycolide (PGA);poly(103-hydroxybutyrate) (PH₃B); poly(103-hydroxyvalerate) (PHV); andpoly(p-dioxanone) (PPDO). It may be difficult to synthesize 100% Ahomopolymers. The A homopolymers may thus contain a small percentage ofresidual B monomers. For example, exemplary A homopolymers may contain asmall percentage (e.g., up to about 10% by weight) of B monomers.

The B polymer blocks are biodegradable, bioabsorbable, elastomerichomopolymers or co-polymers, which are predominantly amorphous and maybe characterized by a relatively low to moderate glass transitiontemperature (Tg). In illustrative examples, the B polymers ashomopolymers or co-polymers may be characterized by glass transitiontemperature (Tg) of at least about −40° C., more particularly at leastabout −30° C., and more particularly at least about −20° C. In addition,or in the alternative, the B homopolymers or co-polymers may becharacterized by a crystallinity as measured by X-ray diffraction of atmost about 25%, more particularly at most about 10%, or moreparticularly at most about 5%. In addition, or in the alternative, the Bpolymers as homopolymers or co-polymers may have a molecular weight offrom about 20 to about 80 kDa, more particularly from about 30 to about70 kDa, and more particularly, from about 40 to about 65 kDa. Inaddition, or in the alternative, the B polymers as homopolymers may havea an entanglement molecular weight of from about 3 to 4 kDa.

Exemplary B homopolymers or co-polymers comprise monomers selected fromthe group consisting of: caprolactone (CL), L-Lactide (LLA), D,L-Lactide((D,L)LA), Glycolide (GA), Polydioxanone (PDO), Trimethylene carbonate(TMC), sebacic acid (SA), 1,6-bis(carboxyphenoxy)hexane (CPH), andcombinations thereof. As another merely illustrative example, B polymersor co-polymers may be selected from the group of:caprolactone-co-glycolide (CAP-co-GLY); poly(L-lactide)-co-glycolide(PLGA); poly(D,L-lactide) (P(D,L)LA); poly(caprolactone)-co-glycolide(PCL-co-GA); poly[(1,6-bis(p-carboxyphenoxy)hexane)-co-sebacic acid(PCPH-co-SA); poly(trimethylene carbonate) (PTMC); poly(trimethylenecarbonate)-co-glycolide (PTMC-co-GA; and poly(trimethylenecarbonate)-co-caprolactone (PTMC-co-CL).

The C polymer blocks are biodegradable, bioabsorbable, hydrophilichomopolymers or co-polymers and may be characterized by miscibility withwater at 37° C. Exemplary C homopolymers and co-polymers may be selectedfrom the group of: polyethylene oxide (PEO); polyethyleneoxide-co-polypropylene oxide (PEO-co-PPO); polyethyleneoxide-co-polysulfone (PEO-co-PSO); polyvinylpyrrolidine (PVP);polyacrylic acid (PAA); and polyvinyl alcohol (PVOH).

In an illustrative example of a useful A-B-C block terpolymer, A isglycolide (GLY), B is a co-polymer of caprolactone-glycolide(CAP-co-GLY) and C is polyethylene oxide (PEO).

XXX. TECHNIQUES FOR PROVIDING AND/OR IMPROVING ADHESION OF BUTTRESS TOWET END EFFECTOR

One of ordinary skill in the art will recognize that, during some usesof instrument (10), the operator may need to actuate end effector (40)several times within a patient. Each actuation may require the operatorto remove end effector (40) from the patient, reload a new staplecartridge (70) into lower jaw (50), apply new buttress assemblies (100,110) to anvil (60) and staple cartridge (70), and then insert thereloaded end effector (40) into the patient. Each time end effector (40)is removed from the patient, anvil (60) may be substantially wet withbodily fluids from the patient and/or other fluids in the surgicalfield. Even when a new cartridge (70) is installed in lower jaw (50),the new cartridge (70) may also receive fluids from other portions ofend effector (40) that were already wet. The presence of fluids onunderside (65) of anvil (60) and/or on deck (73) of staple cartridge(70) may make it difficult to adhere buttress assemblies (100, 110) toanvil (60) and staple cartridge (70). The following examples relate tovarious compositions and configurations that may be used to promoteproper adhesion of buttress assemblies (100, 110) to anvil (60) andstaple cartridge (70) when buttress assemblies (100, 110) to anvil (60)and staple cartridge (70) are wet with one or more fluids.

A. Adhesion of Buttress to Wet End Effector Using Humidity TolerantAdhesive Materials

In some surgical applications, it may be desirable to provide a buttressbody (102, 112) with one or more humidity tolerant adhesive materialsthat will at least temporarily adhere to a wet end effector (40),particularly when it is being used intraoperatively. In some instances,humidity tolerant adhesive materials may provide for temporaryattachment of a buttress body (102, 112) to the wet deck (73) of staplecartridge (70) or the wet underside (65) of anvil (60). A humiditytolerant adhesive material is defined herein as an adhesive materialthat holds a buttress body (102, 112) in place on an anvil (60) orstaple cartridge (70) for at least five minutes in an environment of100% relative humidity (e.g., in a patient's body, at a normal bodytemperature of approximately 37° C.), preferably after the buttress body(102, 112) has been exposed to a relative humidity of from about 20% toabout 60% for up to one hour at room temperature (e.g., betweenapproximately 20° C. and approximately 22° C.). In some instances, ahumidity tolerant adhesive material may hold a buttress body (102, 112)in place on an anvil (60) or staple cartridge (70) for at least tenminutes in an environment of 100% relative humidity (e.g., in apatient's body, at a normal body temperature of approximately 37° C.),preferably after the buttress body (102, 112) has been exposed to arelative humidity of from about 20% to about 60% for up to one hour atroom temperature (e.g., between approximately 20° C. and approximately22° C.). A pressure sensitive humidity tolerant adhesive material isdefined herein as a humidity tolerant adhesive material that can betransferred from a delivery device onto an anvil (60) or staplecartridge (70) by the pressure respectively exerted by the anvil (60) orstaple cartridge (70).

As noted above, FIG. 4 shows buttress assemblies (100, 110) that eachcomprises a buttress body (102, 112) and an adhesive layer (104, 114).adhesive layers (104, 114) respectively provide for temporary attachmentof the buttress bodies (102, 112) to underside (65) of anvil (60) anddeck (73) of staple cartridge (70). It should be understood that thehumidity tolerant adhesive material need not necessarily constitute aseparate adhesive layer (104, 114) that is discretely identifiable asbeing different from a layer defined by buttress body (102, 112).Examples of humidity tolerant adhesive materials that may be otherwiseintegrated onto or into a buttress body (102, 112) are described infurther detail below.

In some instances, the humidity tolerant adhesive materials (e.g., oneor more of layers (104, 114)) for a buttress body (102, 112), comprisepolymers that are either bioabsorbable or of a molecular weight that issufficiently low so as to be cleared from the patient's body (e.g., lessthan approximately 30,000 KDa). Various physiomechanical properties ofpolymers may be modified in order to provide different adhesiveproperties. Such variable characteristics include but are not limited tothe following: copolymer composition; copolymer architecture (e.g.,random vs. block configurations, polymer branching, etc.); glasstransition temperature (Tg); molecular weight; crystallinity; sequencedistribution; copolymer chain composition; melting temperature (Tm);solubility or dissolution rate; rheological properties; surface tension;and combinations thereof. Several exemplary combinations of thesevariables will be provided below, though it should be understood thatthese examples are merely illustrative.

In addition or in the alternative to the aforementioned modifications tothe physiomechanical properties of polymers, some exemplary humiditytolerant adhesive materials may comprise polymers that are combined withsorbents. Useful sorbents may be selected from the group consisting of:polysaccharides such as cellulose; cellulose derivatives, e.g., sodiumcarboxymethylcellulose (Na-CMC); starch; starch derivates; natural gums,e.g., agar and alginates; chitosan; pectin; gelatin; and combinationsthereof. In some examples, a hydrocolloid of one or more sorbents may bemixed with the polymers. In some examples, the humidity tolerantadhesive material comprises a blend of sorbent and polymer in a ratio ina range of 70:30 sorbent to polymer, more particularly in a range of50:50 sorbent to polymer, more preferably in a range of 10:90 sorbent topolymer. Generally it is theorized, but in no way limits the scope ofthis invention, that sorbents may act to absorb moisture away from thesurface interface between the humidity tolerant adhesive material andthe surface to which it is adhered (e.g., a wet end effector (40)), andto maintain the adherence of the buttress body (102, 112) to saidsurface until such time as the buttress body (102, 112) is deployed orreleased from end effector (40) (see, for example, FIG. 5C).

One of the aforementioned physiomechanical properties of polymers isglass transition temperature (Tg). Glass transition temperature is thetemperature at which the mechanical properties of a copolymer changedramatically from a flowable adhesive to a brittle plastic. It may thusbe of importance that the glass transition temperature (Tg) issufficiently below the operating temperature of the humidity tolerantadhesive material in order to allow for sufficient polymer chainmobility. The melting temperature (Tm) of a polymer may be referred toas the “first-order transition,” which is where the polymer changesstate from solid to liquid. Crystalline polymers have a true meltingpoint, which is the temperature at which the crystallites melt and thetotal mass of plastic becomes liquid. Amorphous polymers do not have atrue melting point, but they do have a first-order transition whereintheir mechanical behavior transitions from a rubbery nature to viscousrubbery flow. Suitable polymers for use in humidity tolerant adhesivematerials may be semi-crystalline, i.e., they may have both amorphousand crystalline segments. Suitable polymers may have a melting pointthat is sufficiently above the operating temperature of the humiditytolerant adhesive material to maintain cohesive strength and to providedimensional stability of the applied humidity tolerant adhesivematerial.

The molecular weight of non-bioabsorbable polymers should be high enoughto provide mechanical strength to the resulting adhesive material inorder to avoid cohesive failure, yet low enough that they can be clearedby the patient's body. In the case of biodegradable polymers, an upperlimit on molecular weight may not be required to provide polymerbreakdown products are small enough to be cleared by the patient's body.

The solubility or dissolution rate of polymers in the aqueousenvironments that may be encountered during surgery depend upon a numberof polymer characteristics including, but not limited to: polymercomposition; polymer architecture; degree of cross-linking; blocklength; crystallinity; molecular weight; branching; and combinationsthereof. In illustrative examples described below, certain polymers andco-polymers are chosen and combined with these characteristics in mindin order to decrease the dissolution rate of the resulting humiditytolerant adhesive materials that are of use for adhering a buttress body(102, 112) to a wet end effector (40) during surgery, and maintainingthe adherence of the buttress body to the wet end effector (40) untilsuch time as the buttress body (102, 112) is deployed or released fromend effector (40) (see, for example, FIG. 5C).

The surface tension and rheology of polymers present in a humiditytolerant adhesive material may also impact its adhesive properties. Forexample, if there is a sufficiently large mismatch between the surfacetension of the polymers and the surfaces to which it will adhere,adhesion between the two may be energetically unfavorable. Similarly,the rheological properties of the polymer such as bulk modulus may besuch that the humidity tolerant adhesive material can flow to conform tothe surface topography of the end effector (40), while at the same timeproviding sufficient integrity to maintain cohesive strength and resistshearing and peeling of the buttress body (102, 112) from the endeffector (40).

1. Exemplary Humidity Tolerant Adhesive Materials Comprising PoloxamerBlends

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) may comprise ablend of “plastic fats”, more particularly, poloxamers. In illustrativeexamples, the blend of poloxamers may comprise a blend of poloxamersselected from the group consisting of: poloxamer 188, for exampleKolliphor® P188 from BASF (Florham Park, N.J.); Synperonic® PE/P84 fromCroda Inc. (Edison, N.J.); poloxamer 124, for example Pluronic® L44 fromBASF (Florham Park, N.J.); poloxamer 407, for example Pluronic® F-127from BASF (Florham Park, N.J.); and combinations thereof. Preferably,the poloxamers are of National Formulary grade. The resultingpoloxamer-based humidity tolerant adhesive materials may be putty-likematerials with a relatively low crystallinity and low glass transitiontemperature (Tg). Generally it is theorized, but in no way limits thescope of this invention, that the presence of polypropylene oxide repeatunits in the backbone of the poloxamers provides for a poloxamer blendhaving a slower dissolution rate, which may desirably provide forhumidity tolerant adhesive materials having a greater humidity (i.e.,wetness) tolerance. In turn, a buttress body (102, 112), to whichpoloxamer-based adhesive materials have been applied, may desirablyremain adhered to a wet end effector (40) of a surgical staplinginstrument (10) during a surgical procedure until such time as buttressbody (102, 112) is deployed (see, for example, FIG. 5C).

In some examples, the humidity tolerant adhesive materials comprise apoloxamer blend of poloxamer 188 and Synperonic® PE/P84 in a molar ratioin the range of from 1:3 to 1:4 of poloxamer 188 to Synperonic® PE/P84.In some other examples, humidity tolerant adhesive materials comprise apoloxamer blend of poloxamer 188 and poloxamer 124 in a molar ratio inthe range of from about 1:1 to about 1:4, more particularly from about1:1.5 to about 1:3, of poloxamer 188 to poloxamer 124. In yet some otherexamples, the poloxamer blend may comprise a blend of poloxamer 407 andpoloxamer 124 in a molar ratio in the range of from about 1:1, to about1:5, more particularly from about 1:1.5 to about 1:3 of poloxamer 407 topoloxamer 124.

In yet some other examples, the poloxamers may be combined withnon-ionic surfactants to modify the hydrophobicity of the resultinghumidity tolerant adhesive material. In some such examples, thepoloxamers may be combined with non-ionic surfactants selected from thegroup consisting of: polysorbates; polyethylene glycol hexadecyl ether,for example Brij 52 from Croda Inc. (Edison, N.J.); sorbitanemonooleate, for example, Span® 80 from Sigma Aldrich (Saint Louis, Mo.);and combinations thereof.

In each of the foregoing exemplary poloxamer blends, it may be importantto control the crystallite size of the poloxamers in order to achievethe desirable adhesive characteristics in the resulting humiditytolerant adhesive material.

2. Exemplary Humidity Tolerant Adhesive Materials ComprisingPolyethylene Glycol or Polyethylene-Polyethylene Glycol Co-Polymer

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) comprisepolyethylene glycol (PEG) or polyethylene-polyethylene glycolco-polymers (PE-co-PEG). The resulting humidity tolerant adhesivematerials may be putty-like, malleable and extrudable.

In yet further examples, the pressure sensitive humidity tolerantadhesive materials comprise, or consist essentially of,polyethylene-polyethylene glycol co-polymers (PE-co-PEG) with amolecular weight that is sufficiently low so as to be cleared from thepatient's body (e.g., less than approximately 30,000 KDa).

In yet further examples, the humidity tolerant adhesive materialscomprise a blend of polyethylene-polyethylene glycol copolymers(PE-co-PEG) and poly(caprolactone)-glycolide copolymers (PCL/PGA) in theratio of about 40:60 PCL:PGA, preferably in a ratio of about 50:50PCL:PGA, more preferably in a ratio of about 60:40 PCL:PGA. Such a blendmay have low crystallinity and may even be near amorphous.

In yet further examples, the humidity tolerant adhesive materialscomprise a blend of polyethylene glycol having different molecularweights that is in turn blended with a polymer or co-polymer selectedfrom the group consisting of: poloxamers; poly(caprolactone)-glycolidecopolymers (PCL/PGA); lactide (PLA); and combinations thereof. By way ofexample only, the blend may include polyethylene glycol 3350 (PEG 3350),polyethylene glycol 400 (PEG 400), and/or other polyethylene glycols.

In yet further examples, the humidity tolerant adhesive materialscomprise a block copolymer of polyethylene glycol 20,000 (PEG 20,000)and poly(caprolactone)-glycolide copolymers (PCL/PGA) that arecharacterized by a molar ratio of 65:35 poly(caprolactone) (PCL) toglycolide (PGA). The resulting blends may have a relatively highmolecular weight and lower solubility.

As yet another merely illustrative example, the humidity tolerantadhesive materials comprise a blend of other water soluble copolymerswith poloxamers or PEG, with a molecular weight low enough to be clearedfrom the patient's body. Such a blend may be substituted for a componentof any of the blends described above; or for the entirety of any of theblends described above. By way of further example only, the polymer(s)in such a blend may be biodegradable such as PCL/PGA, etc.

3. Exemplary Humidity Tolerant Adhesive Materials Comprising SolidTriglycerides in Oil

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) comprise“plastic fats” comprising solid triglycerides in oil. In someillustrative examples, such humidity tolerant adhesive materials furthercomprise sorbents. Useful sorbents may be selected from the groupconsisting of: polysaccharides such as cellulose; cellulose derivatives,e.g., sodium carboxymethylcellulose (Na-CMC); starch; starch derivates;natural gums, e.g., agar and alginates; chitosan; pectin; gelatin; andcombinations thereof. Useful triglycerides may be selected from thegroup consisting of: decanoyl glycerides; octanoyl glycerides; andcombinations thereof—for example, Miglyol® 810, 812, 818 and 829 fromCaesar & Loretz GMBH (Hilden, Del.). Useful oils may be selected fromthe group consisting of: bis-diglyceryl polyacyladipate-1; glyceroltrioheptanoate; and combinations thereof—for example, Softisan® 645 andSpezialöl 107 from Cremer Care (Hamburg, GE). The resulting humiditytolerant adhesive materials may desirably provide for good adhesion toend effector (40) and good spreading properties.

4. Exemplary humidity Tolerant Adhesive Materials ComprisingHydrocolloid Gels

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) comprisehydrocolloid gels. In some illustrative examples, useful hydrocolloidgels may be selected from the group consisting of gels comprising:chitosan; carboxymethyl cellulose (CMC); ethyl cellulose;hydroxypropylmethyl cellulose; gelatin; and combinations thereof. Theresulting humidity tolerant adhesive materials may have a relativelyhigh water binding capacity.

B. Exemplary Patterning of Humidity Tolerant Adhesive Materials onButtress Body

Patterning of humidity tolerant adhesive material on a buttress body(102, 112) may be utilized to impact the strength of the adhesive bondof the buttress body (102, 112) to an end effector (40), particularly awet end effector (40). In exemplary embodiments in which it is desiredto reduce the overall adhesion of a buttress body (102, 112) to an endeffector (40) so that it may be more easily deployed or released fromend effector (40) (as in FIG. 5C for example), the humidity tolerantadhesive material may be applied to a buttress body (102, 112) in apattern selected from the group consisting of: stripes; discrete dots;lattices; and combinations thereof. Conversely, in exemplary embodimentsin which it is desired to increase the overall adhesion of a buttressbody (102, 112) to an end effector (40) so that it less readily deployedor released from end effector (40) (as in FIG. 5C for example), thehumidity tolerant adhesive materials may be applied in an adhesive layer(104, 114), that extends continuously along the entire surface ofbuttress body (102, 112).

FIG. 183 shows an exemplary buttress body (11702) in which humiditytolerant adhesive material is applied to the buttress body (11702) in apattern of obliquely oriented stripes (11704). Generally it istheorized, but in no way limits the scope of this invention, thatoblique stripes (11704) present a continuous line to resist side loadsthat may be encountered during surgery by a buttress body (11704) thathas been adhered to an end effector (40). In addition, it is believedthat oblique stripes (11704) minimize the percentage of area that iscoated by the adhesive material along the axis of the buttress body(11702) in the direction of the forces that will release the buttressbody (11702), so as allow the buttress body (11702) to be readilydeployed from the end effector (40) during a surgical procedure (as inFIG. 5C for example). In the present example, oblique stripes (11704)are oblique in the sense that stripes (11704) extend along paths thatare obliquely oriented relative to axes that are parallel to thelongitudinal axis of buttress body (11702). In some exemplaryvariations, stripes (11704) extend along axial paths that are parallelto the longitudinal axis of buttress body (11702).

FIG. 184 depicts a perspective view of an exemplary buttress body(11802) in which humidity tolerant adhesive material has been applied ina pattern of discrete, semi-rigid dots (11804). The discrete, rigidsemi-dots (11804) may be sized and positioned to correspond with thepositioning of staple forming pockets (64) of anvil (60). Thus, thediscrete, semi-rigid dots of adhesive material (11804) are may bearranged in four longitudinally extending linear arrays, with eachlongitudinally extending linear array corresponding the longitudinallyarrayed arrangement of staple forming pockets (64) of anvil (60).Alternatively, any other suitable arrangement may be used. Generally itis theorized, but in no way limits the scope of this invention, thatadding the rigid dots (11804) boosts the modulus of the humiditytolerant adhesive material, while having little impact on its cohesivestrength.

FIG. 185 shows how buttress body (11902) provides a lattice defining aplurality of cells (11908). Due to the presence of cells (11908) and theporous nature of buttress body (11902), when the humidity tolerantadhesive material (11904) is applied to the buttress body (11902), itforms a lattice pattern by entering into some of those cells (11908),thereby partially infusing buttress body (11902) with the adhesivematerial. In other words, buttress body (11902) acts like a spongeabsorbing the adhesive material, allowing the adhesive material todeform, surround, and essentially grab hold of the lattice connectionswithin buttress body (11902).

In some instances, the humidity tolerant adhesive material is initiallyapplied to buttress body (11902) when the adhesive material is in arelatively highly viscous form. Buttress body (11902) is then heated todecrease the viscosity of the adhesive material, causing the adhesivematerial to enter some of the cells (11908) of buttress body (11902).Buttress body (11902) is then cooled or allowed to cool, causing theviscosity of the adhesive material to increase back to its previousstate. Buttress body (11902) may then be heated again as buttress body(11902) is being applied to end effector (40) as described above. Insome other versions, the adhesive material already has a low enoughviscosity to enter cells (11908) when the adhesive material is applied,without requiring the adhesive material to be heated. In other words,the adhesive material may wick into cells (11908) of buttress body(11902). In some such versions, a protective film (e.g.,polytetrafluoroethylene (PTFE)) may be applied over the adhesivematerial to protect and/or contain the adhesive material before buttressbody (11902) is applied to end effector (40). Other suitable ways inwhich buttress assembly (11902) may be formed and provided are disclosedin U.S. patent application Ser. No. 14/667,842, entitled “Method ofApplying a Buttress to a Surgical Stapler,” filed Mar. 25, 2015, thedisclosure of which is incorporated by reference herein.

C. Reduction of Spontaneous Separation of Buttress from HumidityTolerant Adhesive Material

In some surgical applications, it may be desirable to reduce thespontaneous separation of a buttress body (102, 112) from the humiditytolerant adhesive material that has been applied thereto. Suchspontaneous separation or “de-wetting” may occur as a result of moisturebeing present on the end effector (40) to which the buttress body (102,112) has been adhered. In some instances, de-wetting may be minimized byone or more steps selected from the group consisting of: drying;priming; absorbing water; and combinations thereof. Each of these stepsis explained in further detail below.

In some instances, de-wetting may be minimized by drying the endeffector (40) prior to adhering a buttress body (102, 112) thereto. Inexemplary embodiments, drying the end effector (40) may be accomplishedby applying an absorbent to the end effector (40). For instance, endeffector (40) may be temporary clamped onto an absorbent platform (e.g.,comprising a polyacrylate pad) in order to substantially dry underside(65) of anvil (60) and deck (73) of staple cartridge (70) as describedin U.S. Patent App. No. 62/209,041, entitled “Method and Apparatus forApplying a Buttress to an End Effector of a Surgical Stapler,” filedAug. 24, 2015, the disclosure of which is incorporated by referenceherein. Other suitable ways in which end effector (40) may be driedprior to adhering a buttress body (102, 112) thereto will be apparent tothose of ordinary skill in the art in view of the teachings herein.

In some instances, de-wetting may be additionally or alternativelyminimized by priming the end effector (40) with a hydrophobic layerprior to adhering a buttress body (102, 112) thereto. In exemplaryembodiments, a sponge with an adhesive-miscible hydrophobe may beclamped onto the end effector (40) to make it temporarily hydrophobicprior to adhering a buttress body (102, 112) thereto. In exemplaryembodiments, adhesive-miscible hydrophobes may be selected from thegroup consisting of: ethyl citrate; triacetin; triolein; andcombinations thereof.

In some versions, the adhesive-miscible hydrophobes may be applied asfollows. One or more adhesive-miscible hydrophobes may be pre-loadedinto an open cell foam layer. The open cell foam layer may be loaded andsqueezed between the buttress bodies (102, 112) after the buttressbodies (102, 112) have been adhered onto the anvil (60) and lower jaw(50) of the end effector (40). During squeezing of the open cell foamlayer, at least a portion of the adhesive-miscible hydrophobe(s) maymigrate from the open cell foam layer, through the buttress bodies (102,112) to the interface between the humidity tolerant adhesive materialand the anvil (60) or staple cartridge (70) of the end effector (40),creating a temporarily hydrophobic environment that may be favorable tomaintaining good adhesive properties.

In some instances, de-wetting may be additionally or alternativelyminimized by coating all or a portion of the end effector (40), e.g. theanvil (60) and/or staple cartridge (70), with a hydrophobic lubriciouscoating comprising calcium stearate or magnesium stearate.

In some instances, de-wetting may be additionally or alternativelyminimized by absorbing moisture away from the surface of the endeffector (40). In some such versions, this may be accomplished by mixinga hydrocolloid into the humidity tolerant adhesive material at the timethat the adhesive is made. Generally it is theorized, but in no waylimits the scope of this invention, that hydrocolloids provide theresulting humidity tolerant adhesive material with wet tackcharacteristics that enable the adhesive material to stick to both wetand dry surfaces. Suitable compositions that may form the hydrocolloidmay be selected from the group consisting of: carboxy methylcellulose(CMC); gelatin; hyaluronate; and combinations thereof.

In some instances, moisture may additionally or alternatively beabsorbed away from the surface of the end effector (40) by adding ahydrophilic block to one of the polymers or co-polymers that form thehumidity tolerant adhesive material. Suitable hydrophilic blocks may beselected from the group consisting of: polyethylene glycol (PEG);polyvinyl pyrrolidine (PVP); and combinations thereof.

D. Reduction of Forces on Buttress Bodies Against Tissue

As noted above in reference to FIG. 6, a series of staples (1190) maycapture and retain buttress assemblies (100, 110) against layers oftissue (T₁, T₂), thereby securing buttress assemblies (100, 110) totissue (T₁, T₂). In some surgical procedures, it may be desirable toreduce forces that are exerted against the buttress assemblies (100,110) when they are being placed, or are in place, against the layers oftissue (T₁, T₂). Such a reduction in force may allow for better adhesionof the buttress bodies (102, 112) to the end effector (40). In addition,or in the alternative, it may be desirable to reduce forces that maydamage the layers of tissue (T₁, T₂) that are to be, or have been,secured. In illustrative examples, this may be accomplished by treatingthe tissue-contacting surfaces of one or more buttress assemblies (100,110) so that they become lubricious. Generally it is theorized, but inno way limits the scope of this invention, that a lubricious buttressbody (102, 112) surface may reduce the shear force, i.e., drag force,that is applied between the layers of tissue (T₁, T₂) and buttressassemblies (100, 110). Exemplary substances that may be applied to thetissue-contacting surfaces of one or more buttress assemblies (100, 110)to make them lubricious may be selected from the group consisting of:polyethylene glycol 200 (PEG 200); silicone; oil; and combinationsthereof.

In further illustrative examples, forces may additionally oralternatively be reduced by modifying the edges of the buttress bodyassembly (100, 110). Generally it is theorized, but in no way limits thescope of this invention, that such modifications of the edges of thebuttress body assembly (100, 110) may minimize snagging and/or grippingon the layers of tissue (T₁, T₂) by the buttress assemblies (100, 110)when they are being placed, or are in place, against the layers oftissue (T₁, T₂), and vice versa. Useful means of modifying the edges ofthe buttress body assembly (100, 110) may be selected from the groupconsisting of: radiusing; chamfering; and combinations thereof.

XXXI. EXEMPLARY COMBINATIONS

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

A method of securing a buttress to an end effector, wherein the endeffector comprises an upper jaw member and a lower jaw member, themethod comprising: (a) positioning a platform of a buttress appliercartridge between the upper and lower jaw members while the upper andlower jaw members are in an open configuration, wherein the platform hasa buttress disposed thereon during the act of positioning the platformbetween the upper and lower jaw members, wherein the buttress appliercartridge has at least one retainer member retaining the buttress on theplatform during the act of positioning the platform between the upperand lower jaw members; (b) driving one or both of the upper or lower jawmembers toward the platform to thereby engage the buttress with the endeffector, wherein the buttress applier cartridge further comprises aresilient member that drives the at least one retainer away from thebuttress to thereby release the buttress in response to the act ofdriving one or both of the upper or lower jaw members toward theplatform; and (c) driving one or both of the upper or lower jaw membersway from the platform to thereby pull the buttress off of the platform.

Example 2

The method of Example 1, wherein the platform applies at least twodifferent amounts of pressure against the first buttress assembly inresponse to the act of driving one or both of the upper or lower jawmembers toward the platform to thereby engage the buttress with the endeffector.

Example 3

The method of any one or more of Examples 1 through 2, furthercomprising: (a) actuating the end effector on tissue, thereby providinga spent staple cartridge; and (b) attempting to close the actuated endeffector about a second platform of a second buttress applier cartridge,wherein the second platform has features that engage the spent staplecartridge and thereby prevent full closure of the actuated end effectorabout the second platform.

Example 4

The method of one or more of Examples 1 through 3, further comprisingviewing an indicator on the buttress applier cartridge to confirm thatthe buttress applier cartridge is loaded before performing the act ofdriving one or both of the upper or lower jaw members toward theplatform.

Example 5

The method of one or more of Examples 1 through 4, further comprisingchanging a state of an indicator on the buttress applier cartridge inresponse to the act of driving one or both of the upper or lower jawmembers toward the platform.

Example 6

The method of one or more of Examples 1 through 5, further comprisingdriving a fluid from the buttress in response to the act of driving oneor both of the upper or lower jaw members toward the platform.

Example 7

The method of Example 6, wherein the buttress applier cartridge has areservoir that receives some of the fluid driven from the buttress inresponse to the act of driving a fluid from the buttress.

Example 8

The method of one or more of Examples 1 through 7, further comprisingreceiving feedback from the buttress applier cartridge confirmingsuccessful closure of the end effector about the platform.

Example 9

The method of one or more of Examples 1 through 8, wherein the buttressapplier cartridge further comprises a latch, wherein the latch securesthe position of the retainer member during the act of positioning theplatform between the first and second jaw members, wherein the act ofdriving one or both of the upper or lower jaw members toward theplatform comprises: (i) engaging a first portion of the latch with theupper jaw member, and (ii) engaging a second portion of the latch withthe lower jaw member while simultaneously engaging the first portion ofthe latch with the upper jaw member, wherein the simultaneous engagementof the first and second portions of the latch causes the latch torelease the at least one retainer, wherein the release of the at leastone retainer by the latch causes the at least one retainer to releasethe buttress from the platform.

Example 10

The method of one or more of Examples 1 through 9, wherein the act ofdriving one or both of the upper or lower jaw members toward theplatform further comprises activating a data communication feature.

Example 11

The method of Example 10, wherein the act of activating a datacommunication feature comprises receiving electronic data wirelesslyfrom the buttress applier cartridge.

Example 12

The method of one or more of Examples 1 through 11, further comprisingviewing an indicator on the buttress applier cartridge to confirm thatthe buttress applier cartridge has not been exposed to an adverseenvironmental condition before performing the act of driving one or bothof the upper or lower jaw members toward the platform.

Example 13

The method of one or more of Examples 1 through 12, further comprisingviewing a display screen on the buttress applier cartridge to observe acharacteristic of the buttress applier cartridge before performing theact of driving one or both of the upper or lower jaw members toward theplatform.

Example 14

The method of one or more of Examples 1 through 13, further comprising:(a) opening a container cover of a container; (b) retrieving thebuttress applier cartridge from the container; and (c) removing abuttress cover from the buttress to expose an adhesive on the buttress.

Example 15

The method of Example 14, wherein the buttress cover is secured to thecontainer cover such that the act of opening the container cover and theact of removing the buttress cover are performed simultaneously.

Example 16

The method of one or more of Examples 1 through 15, further comprisingactuating the end effector, wherein the act of actuating the endeffector comprises driving a first plurality of staples from the endeffector through at the buttress.

Example 17

The method of Example 16, wherein the act of actuating the end effectorfurther comprises driving a second plurality of staples from the endeffector separately from the buttress.

Example 18

The method of one or more of Examples 1 through 17, further comprisingsliding the platform longitudinally relative to a housing of thebuttress applier cartridge.

Example 19

A method of securing series of buttresses to an end effector, whereinthe end effector comprises an upper jaw member and a lower jaw member,the method comprising: (a) positioning a platform of a buttress appliercartridge between the upper and lower jaw members while the upper andlower jaw members are in an open configuration, wherein the platform hasa plurality of buttresses disposed thereon; (b) closing the jaw membersabout the platform to adhere a first buttress of the plurality ofbuttresses to the end effector; (c) opening the jaw members to pull thefirst buttress from the platform; (d) actuating the end effector in apatient, thereby securing the first buttress in the patient; (e) closingthe jaw members about the platform to adhere a second buttress of theplurality of buttresses to the end effector; (f) opening the jaw membersto pull the second buttress from the platform; and (g) actuating the endeffector in a patient, thereby securing the second buttress in thepatient.

Example 20

A method of securing a buttress to an end effector, wherein the endeffector comprises an upper jaw member and a lower jaw member, themethod comprising: (a) positioning a platform of a buttress appliercartridge between the upper and lower jaw members while the upper andlower jaw members are in an open configuration, wherein the platform hasa buttress disposed thereon; (b) observing a first alignment marking onthe end effector in relation to a second alignment marker on thebuttress applier cartridge to confirm proper alignment of the endeffector relative to the buttress applier cartridge; (c) closing the jawmembers about the platform to adhere the buttress to the end effector;(d) opening the jaw members to pull the buttress from the platform; and(e) observing alignment markings on the buttress in relation to the endeffector to confirm proper alignment of the buttress relative to the endeffector.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7816USNP.0630315], entitled “Surgical Stapler ButtressApplicator with End Effector Actuated Release Mechanism,” filed on evendate herewith, the disclosure of which is incorporated by referenceherein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7816USNP1.0630317], entitled “Surgical Stapler ButtressApplicator with Multi-Zone Platform for Pressure Focused Release,” filedon even date herewith, the disclosure of which is incorporated byreference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7816USNP2.0630319], entitled “Surgical Stapler ButtressApplicator with Spent Staple Cartridge Lockout,” filed on even dateherewith, the disclosure of which is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7816USNP3.0630293], entitled “Surgical Stapler ButtressApplicator with State Indicator,” filed on even date herewith, thedisclosure of which is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7816USNP4.0630295], entitled “Surgical Stapler ButtressApplicator with Multi-Point Actuated Release Mechanism,” filed on evendate herewith, the disclosure of which is incorporated by referenceherein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7818USNP.0630118], entitled “Surgical Stapler ButtressApplicator with Data Communication,” filed on even date herewith, thedisclosure of which is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7806USNP.0630310], entitled “Surgical Stapler ButtressAssembly with Gel Adhesive Retainer,” filed on even date herewith, thedisclosure of which is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7808USNP.0630110], entitled “Fluid Penetrable ButtressAssembly for Surgical Stapler,” filed on even date herewith, thedisclosure of which is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7812USNP.0630112], entitled “Surgical Stapler ButtressAssembly with Features to Interact with Movable End EffectorComponents,” filed on even date herewith, the disclosure of which isincorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7815USNP.0630114], entitled “Extensible Buttress Assemblyfor Surgical Stapler,” filed on even date herewith, the disclosure ofwhich is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7817USNP.0630116], entitled “Extensible Buttress Assemblyfor Surgical Stapler,” filed on even date herewith, the disclosure ofwhich is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7820USNP.0630297], entitled “Multi-Layer Surgical StaplerButtress Assembly,” filed on even date herewith, the disclosure of whichis incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7809USNP.0630312], entitled “Surgical Stapler ButtressAssembly with Humidity Tolerant Adhesive,” filed on even date herewith,the disclosure of which is incorporated by reference herein.

Any of the Examples set forth in U.S. patent application No. [ATTORNEYDOCKET NO. END7810USNP.0630307], entitled “Surgical Stapler ButtressAssembly with Adhesion to Wet End Effector,” filed on even dateherewith, the disclosure of which is incorporated by reference herein.

XXXII. MISCELLANEOUS

While the terms “buttress” and “buttress assembly” are used throughoutthis disclosure, it should be understood that the term is not intendedto limit the scope of the present invention in any way. For instance,use of the terms “buttress” and “buttress assembly” is not intended todemonstrate contemplation that a “buttress” or “buttress assembly” canonly be used to provide structural support to a staple line or serve anyother particular purpose. It is contemplated that “buttress” or“buttress assembly” may serve a variety of purposes in addition to or asan alternative to providing structural support to a staple line. Theterms “buttress” and “buttress assembly” should therefore be readbroadly to include any kind of adjunct to a staple line that serves anysuitable purpose.

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

In addition to the foregoing, it should also be understood that any ofthe various buttress assemblies described herein may be furtherconstructed and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, the disclosure of which is incorporated by reference herein; U.S.patent application Ser. No. 14/827,856, entitled “Implantable Layers fora Surgical Instrument,” filed Aug. 17, 2015, the disclosure of which isincorporated by reference herein; U.S. patent application Ser. No.14/871,071, entitled “Compressible Adjunct with Crossing Spacer Fibers,”filed Sep. 30, 2015, the disclosure of which is incorporated byreference herein; and U.S. patent application Ser. No. 14/871,131,entitled “Method for Applying an Implantable Layer to a FastenerCartridge,” filed Sep. 30, 2015, the disclosure of which is incorporatedby reference herein. Furthermore, in addition to the methods describedherein, any of the various buttress assemblies described herein may beapplied to end effector (40) in accordance with at least some of theteachings of U.S. Provisional Patent App. No. 62/209,041, entitled“Method and Apparatus for Applying a Buttress to End Effector of aSurgical Stapler,” filed Aug. 24, 2015, the disclosure of which isincorporated by reference herein; and/or U.S. patent application Ser.No. 14/871,131, entitled “Method for Applying an Implantable Layer to aFastener Cartridge,” filed Sep. 30, 2015, the disclosure of which isincorporated by reference herein. Various suitable ways in which theteachings herein may be combined with various teachings of theabove-cited references will be apparent to those of ordinary skill inthe art.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof any of the following: U.S. Pat. No. 5,792,135, entitled “ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery WithEnhanced Dexterity and Sensitivity,” issued Aug. 11, 1998, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.5,817,084, entitled “Remote Center Positioning Device with FlexibleDrive,” issued Oct. 6, 1998, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,878,193, entitled “Automated EndoscopeSystem for Optimal Positioning,” issued Mar. 2, 1999, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,231,565,entitled “Robotic Arm DLUS for Performing Surgical Tasks,” issued May15, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument,” issued Aug. 31, 2004, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.6,364,888, entitled “Alignment of Master and Slave in a MinimallyInvasive Surgical Apparatus,” issued Apr. 2, 2002, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,524,320,entitled “Mechanical Actuator Interface System for Robotic SurgicalTools,” issued Apr. 28, 2009, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,691,098, entitled “Platform Link WristMechanism,” issued Apr. 6, 2010, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,806,891, entitled “Repositioningand Reorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery,” issued Oct. 5, 2010, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2013/0012957, entitled“Automated End Effector Component Reloading System for Use with aRobotic System, published Jan. 10, 2013, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2012/0199630, entitled“Robotically-Controlled Surgical Instrument with Force-FeedbackCapabilities,” published Aug. 9, 2012, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2012/0132450, entitled“Shiftable Drive Interface for Robotically-Controlled Surgical Tool,”published May 31, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199633, entitled “SurgicalStapling Instruments with Cam-Driven Staple Deployment Arrangements,”published Aug. 9, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199631, entitled“Robotically-Controlled Motorized Surgical End Effector System withRotary Actuated Closure Systems Having Variable Actuation Speeds,”published Aug. 9, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199632, entitled“Robotically-Controlled Surgical Instrument with SelectivelyArticulatable End Effector,” published Aug. 9, 2012, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2012/0203247,entitled “Robotically-Controlled Surgical End Effector System,”published Aug. 9, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0211546, entitled “Drive Interfacefor Operably Coupling a Manipulatable Surgical Tool to a Robot,”published Aug. 23, 2012; U.S. Pub. No. 2012/0138660, entitled“Robotically-Controlled Cable-Based Surgical End Effectors,” publishedJun. 7, 2012, the disclosure of which is incorporated by referenceherein; and/or U.S. Pub. No. 2012/0205421, entitled“Robotically-Controlled Surgical End Effector System with RotaryActuated Closure Systems,” published Aug. 16, 2012, the disclosure ofwhich is incorporated by reference herein.

Versions of the devices described above may be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, some versions of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, some versions of the device may bereassembled for subsequent use either at a reconditioning facility, orby a user immediately prior to a procedure. Those skilled in the artwill appreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1-300. (canceled)
 301. A method of securing a buttress to an endeffector with a buttress applier cartridge, wherein the end effectorcomprises a first jaw and a second jaw, wherein the first jaw includesan offset distal tip that projects toward the second jaw, wherein thebuttress applier cartridge comprises a platform, a buttress disposed onthe platform, a retaining member, and a receiving feature, the methodcomprising: (a) positioning the platform between the first and secondjaws while the jaws are in an open state and while the retainer memberretains the buttress on the platform; (b) closing the end effector toclamp the platform between the first and second jaws, wherein inresponse to the clamping action of the end effector: (i) the offsetdistal tip of the first jaw is received by the receiving feature of thebuttress applier cartridge, (ii) one of the first or second jaws engagesthe buttress, and (iii) the retainer member releases the buttress fromthe platform; (c) opening the end effector and thereby removing thebuttress from the platform; and (d) removing the platform from betweenthe first and second jaws while the buttress remains secured to the oneof the first or second jaws.
 302. The method of claim 301, wherein theoffset distal tip of the first jaw comprises a rounded distal tip or anangled distal tip.
 303. The method of claim 301, wherein the receivingfeature comprises an opening located at a distal end of the platform.304. The method of claim 303, wherein the opening is defined at least inpart by a housing of the buttress applier cartridge.
 305. The method ofclaim 304, wherein at least a distal-most portion of the offset distaltip is positioned in non-contact relation with the housing when the endeffector is closed on the platform.
 306. The method of claim 303,wherein the opening extends through the platform.
 307. The method ofclaim 303, wherein the opening is V-shaped.
 308. The method of claim301, wherein in response to the clamping action of the end effector onthe platform, the buttress adhesively bonds to a clamping surface of thejaw, wherein discrete portions of the buttress are adhesively bonded tothe clamping surface with a greater degree of adhesion than otherportions of the buttress.
 309. The method of claim 308, wherein thebuttress includes a plurality of discrete portions of adhesive.
 310. Themethod of claim 308, wherein the platform includes a plurality ofprotrusions that provide localized pressure at discrete portions of thebuttress when the end effector clamps on the platform and the buttress.311. The method of claim 301, wherein the retainer member is movablebetween an extended position and a retracted position, wherein theretainer member in the extended position retains the buttress on theplatform, wherein in response to the clamping action of the end effectoron the platform the retainer member moves to the retracted position torelease the buttress from the platform, wherein the retainer memberremains in the retracted position following removal of the platform frombetween the first and second jaws.
 312. The method of claim 311, whereinthe retainer member is resiliently biased toward the retracted position.313. The method of claim 301, wherein the first jaw supports an anvilsurface, wherein the second jaw supports a staple cartridge.
 314. Themethod of claim 301, wherein the buttress comprises a first buttressdisposed on a first side of the platform, wherein the buttress appliercartridge further comprises a second buttress disposed on second side ofthe platform, wherein in response to the clamping action of the endeffector on the platform the first jaw engages the first buttress andthe second jaw engages the second buttress.
 315. The method of claim301, wherein the retainer member comprises a first retainer member thatreleasably retains the first buttress on the first side of the platform,wherein the buttress applier cartridge further comprises a secondretainer member that releasably retains the second buttress on thesecond side of the platform, wherein in response to the clamping actionof the end effector on the platform the first retainer member releasesthe first buttress from the first side and the second retainer memberreleases the second buttress from the second side.
 316. A method ofsecuring first and second buttresses to an end effector with a buttressapplier cartridge, wherein the end effector comprises a first jaw and asecond jaw, wherein the first jaw, wherein the buttress appliercartridge comprises a platform, an opening located at a distal end ofthe platform, first and second buttresses disposed on the platform, andfirst and second retaining members, the method comprising: (a)positioning the platform between the first and second jaws while thejaws are in an open state and while the first retainer member retainsthe first buttress on a first side of the platform and while the secondretainer member retains the second buttress on a second side of theplatform; (b) closing the end effector to clamp the platform between thefirst and second jaws, wherein in response to the clamping action of theend effector: (i) a distal tip of the first jaw is received into theopening of the buttress applier cartridge, (ii) the first jaw engagesthe first buttress, and (iii) the second jaw engages the secondbuttress; (c) opening the end effector and thereby removing the firstand second buttresses from the platform; and (d) removing the platformfrom between the first and second jaws while the first buttress remainssecured to the first jaw and the second buttress remains secured to thesecond jaw.
 317. The method of claim 316, wherein the opening is formedin a housing of the buttress applier cartridge, wherein the openingcommunicates with an opening in a distal end of the platform.
 318. Themethod of claim 317, wherein in response to the clamping action of theend effector on the platform, the first retainer member releases thefirst buttress from the first side of the platform and the secondretainer member releases the second buttress from the second side of theplatform.
 319. A method of securing a buttress to an end effector with abuttress applier cartridge, wherein the end effector comprises a firstjaw that supports an anvil surface and a second jaw that supports astaple cartridge, wherein the first jaw includes an offset distal tipthat projects toward the second jaw, wherein the buttress appliercartridge comprises a platform, an opening formed in a distal end of theplatform, a buttress disposed on the platform, and a retaining member,the method comprising: (a) positioning the platform between the firstand second jaws while the jaws are in an open state and while theretainer member retains the buttress on the platform; (b) closing theend effector to clamp the platform between the first and second jaws,wherein in response to the clamping action of the end effector: (i) theoffset distal tip of the first jaw is received through the opening ofthe platform, (ii) one of the anvil surface or the staple cartridgeengages the buttress, and (iii) the retainer member releases thebuttress from the platform; (c) opening the end effector and therebyremoving the buttress from the platform; and (d) removing the platformfrom between the first and second jaws while the buttress remainssecured to the one of the anvil surface or the staple cartridge. 320.The method of claim 319, wherein the offset distal tip of the first jawcomprises a rounded distal tip or an angled distal tip.